Lung infiltrate in a male with a bronchopleural fistula.

A 49-yr-old male was admitted to the Pulmonology Unit of Bichat Hospital (Paris, France) in February 2001 due to minor haemoptysis. He had a history of right upper lobe tuberculosis in 1970, complicated with secondary aspergilloma in 1999 and treated with itraconazole between April and October 1999. In November 1999, he presented with right pleural empyema (local samples yielded Pseudomonas aeruginosa and Streptococcus sanguis) due to a bronchopleural fistula (fig. 1a). Right open thoracostomy was performed in December 1999 and daily local care provided for 14 months until admission. On questioning, he denied experiencing fever, weight loss and shortness of breath. Physical examination results were normal. The pleural cavity was clean and sterile and the bronchopleural fistula still open. Laboratory results, including white blood cell count and erythrocyte sedimentation rate, were normal. The chest radiograph is shown in figure 1b. Computed tomography was also performed (fig. 2). Fibreoptic bronchoscopy revealed post-tuberculous scarring in the right bronchial tree. Results of bacteriological and mycological studies were negative, as was the search for Mycobacterium tuberculosis. Bronchoalveolar lavage was performed in the left upper lobe. The resultant fluid was whitish and contained 200,000 cells?mL: 71% macrophages, 21% lymphocytes, 8% neutrophils, and 1% eosinophils. Oil red O stain results are shown in figure 3.