Spontaneous pneumothorax in a patient with tuberculosis-induced destroyed lung successfully treated with autologous blood and minocycline pleurodesis: a case report

Introduction

Pulmonary tuberculosis may culminate in a destroyed lung phenotype, predisposing to spontaneous pneumothorax and prolonged air leak. When operative risk is prohibitive, effective non-surgical strategies are essential (1). We present this article in accordance with the CARE reporting checklist (available at https://acr.amegroups.com/article/view/10.21037/acr-2025-151/rc).

Case presentation

On arrival, the patient maintained adequate oxygenation on room air; supplemental oxygen was not required. Chest radiography (Figure 1) and computed tomography (Figure 2) demonstrated right pneumothorax with extensive fibrotic destruction; a chest tube was inserted (Figure 3). The air leak persisted through day 15.

Figure 1 Chest radiograph on admission showing right-sided pneumothorax with severe volume loss and fibrotic changes in the right lung consistent with destroyed lung due to previous pulmonary tuberculosis.

Figure 2 Chest computed tomography demonstrating extensive fibrotic destruction, cavitation, and severe parenchymal loss of the right lung.

Figure 3 Chest radiograph after chest tube drainage showing persistent pneumothorax despite appropriate tube placement.

On day 16, pleurodesis was performed via the chest tube using minocycline 100 mg + 50 mL normal saline + 50 mL autologous blood (total 100 mL). Because leakage continued, a second pleurodesis with the same regimen was performed 48 hours later (day 18). Within 24 hours after the second pleurodesis, the air leak ceased; follow-up chest radiography (Figure 4) confirmed resolution. The chest tube was removed on day 21, and the patient was discharged in stable condition (see Table 1).

Figure 4 Follow-up chest radiograph after autologous blood and minocycline pleurodesis showing complete resolution of the pneumothorax and full re-expansion of the left lung.

Follow-up

Outpatient visits were scheduled at ~2 weeks, 1 month, and 3 months after discharge. Chest radiographs were obtained at the 2-week and 1-month visits; no recurrence was observed through 3 months. The patient reported satisfactory daily activity with no dyspnea beyond baseline.

Patient perspective

“I agreed to pleurodesis using my own blood and minocycline. I was relieved when the air leak stopped and grateful to avoid surgery. I’m satisfied with the care and recovery.”

Ethics consideration

All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the institutional ethics committee of Tokyo Women’s Medical University Yachiyo Medical Center (IRB No. 5671). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Discussion

Autologous blood pleurodesis is a pragmatic option for persistent air leaks, with clot-mediated pleural adhesion (1). Minocycline enhances pleural inflammation/fibrosis (aiding pleurodesis) and, as a broad-spectrum antibiotic, may reduce the risk of secondary infection during the procedure—important in destroyed lung. Reports specifically addressing post-tuberculosis destroyed lung with combined autologous blood + minocycline are limited; this case adds practice-oriented detail (2). Guideline-based principles for spontaneous pneumothorax management should be considered alongside patient comorbidity and surgical risk (3,4).

Conclusions

Combined autologous blood and minocycline pleurodesis can effectively control persistent air leak in tuberculosis-induced destroyed lung when surgery is high-risk.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the CARE reporting checklist. Available at https://acr.amegroups.com/article/view/10.21037/acr-2025-151/rc

Peer Review File: Available at https://acr.amegroups.com/article/view/10.21037/acr-2025-151/prf

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://acr.amegroups.com/article/view/10.21037/acr-2025-151/coif). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the Declaration of Helsinki and its subsequent amendments. This study was approved by the institutional ethics committee of Tokyo Women’s Medical University Yachiyo Medical Center (IRB No. 5671). Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the editorial office of this journal.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

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