Pleuro-cutaneous fistula complicating chest drain insertion for melioidosis empyema

Abstract

Melioidosis is a rare cause of empyema. Pleurocutaneous fistula is a pathologic communication between the pleural space and the subcutaneous tissues. Here we’re presenting a case of a Pleurocutaneous fistula complicating chest drain insertion for melioidosis empyema. Fifty-year-old fisherman from Mannar Sri Lanka presented with predominant thoracic empyema. Pleural fluid culture isolated the Burkholderia pseudomallei. A chest drain was inserted for the empyema. Subcutaneous emphysema was noted following the removal of the chest drain and it worsened over time. CECT Chest revealed the right Pleuro-cutaneous fistula, which was complicated by hemopneumothorax and trapped lung. Surgical management was refused by the patient for fistula correction and trapped lung. The fistula was successfully closed with an autologous blood patch. Melioidosis can present with predominant thoracic empyema. Pleuro-cutaneous fistula can complicate the chest drain insertion in the patient with melioidosis empyema which can be treated with an Ultrasound-guided autologous blood patch.