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].