Medical Thoracoscopy in Diagnosis and Management of Silicotuberculosis with Pneumothorax: A Report of a Rare Case.

BACKGROUND The diagnosis of silicotuberculosis is rarely reported, even in high-burden countries for tuberculosis like Indonesia. The requirement for an advanced method to diagnose silicosis makes this disease underdiagnosed. Silica detection is a mandatory examination, but not all centers in developing countries can perform it. Once the diagnosis is confirmed, the treatment is also challenging. Patients usually come to the hospital with complications that can be life-threatening. CASE REPORT A 45-year-old Indonesian man with a history of unprotected quarry work and heavy smoking presented with worsening respiratory symptoms during tuberculosis treatment. The chest X-ray in the emergency room showed a left pneumothorax. His discomfort decreased after a chest tube was inserted. A pneumothorax was detected in the right hemithorax, necessitating the insertion of a chest tube. A high-resolution computed tomography examination of the thorax was performed and showed bronchopleural fistulas. Medical thoracoscopy confirmed multiple bronchopleural fistulae. A lung biopsy from thoracoscopy was performed, confirming the presence of silica. After a few days of treatment, the right chest tube was successfully removed. Meanwhile, due to the persistent air leak in the left pleura caused by multiple bronchopleural fistulae, the left chest tube was eventually connected to a dry seal drain, and the patient was scheduled for discharge. CONCLUSIONS This case highlights the successful diagnosis of silicotuberculosis using medical thoracoscopy.