Successful use of autologous blood patch pleurodesis in pneumothorax secondary to pulmonary tuberculosis

Abstract

Persistent air leaks (PALs), defined as air leaks lasting more than 5–7 days, are a challenging complication of pneumothorax that prolong hospitalization and increase infection risk, especially in patients unfit for surgery. Autologous blood patch pleurodesis (ABPP) is a simple, safe, and cost-effective alternative. We report a young man in his 20 s with disseminated tuberculosis, with pulmonary, pleural, CNS and ocular involvement, presented with bilateral spontaneous pneumothorax. He required high-flow nasal oxygen and bilateral intercostal drainage (ICD). Despite initial management and negative suction, persistent bilateral air leaks were noted on imaging. ABPP was performed on left side using 80 mL (2 mL/kg) of autologous blood instilled via ICD, followed by saline flush, tube elevation, and supine positioning. Serial chest radiographs at 4, 24, and 48 hours showed complete resolution of the left-sided pneumothorax, while the right side improved with negative suction. Both ICDs were subsequently removed, and patient was discharged on antitubercular therapy and steroids, with no recurrence on follow-up. ABPP, first described in 1987, has reported success rates exceeding 90%, with proposed mechanisms including pleurodesis through inflammation and mechanical sealing of leaks by clot formation. Compared to chemical pleurodesis, ABPP is less invasive, inexpensive, and associated with fewer adverse effects, including less pain and fever, with shorter hospital stay. This case highlights ABPP as an effective and practical option for managing refractory pneumothorax with persistent air leak.