Discussion
Recent studies on COVID-19 patients showed a pneumothorax prevalence of 1–2% [2][5]. However, bronchopleural fistula is extremely rare in previously fit patients with no complicated hospital course such as mechanical ventilation requirement or superinfection. Although there are a few reported cases of tension pneumothorax among COVID-19 pneumonia patients, bronchopleural fistula in relation to COVID-19 pneumonia has been reported only in very few ones [6][7]. Also, these reported cases were of patients with accompanied issues such as necrotic fungal co-infection [8] and long-term mechanical ventilation [7][9].
We think that patients with no comorbidities nor complicated hospital course might be overlooked for as such a rare complication as bronchopleural fistula. Our patient was middle aged, had no comorbidities, non-smoker, required only continuous positive airway pressure therapy (CPAP) for a short duration, and his CT chest showed signs of pneumonitis with no evidence of lung necrosis. These findings subsequently suggest that the bronchopleural fistula is solely due to COVID-19 pneumonia. So, BPF should be kept in mind in cases of sudden persistent deterioration of COVID-19 pneumonia patients, even with absence of apparent risk factors, and even in patients who have not been placed on mechanical ventilation.
Additionally, our patient was successfully treated conservatively with prolonged chest tube drainage (53 days), which indicates that surgical or more invasive treatment is not always required. On the other hand, the related cases in the literature were treated invasively with, for instance, salvage lobectomy [6], and Endobronchial valves [10].