{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:56:05Z","timestamp":1781697365111,"version":"3.54.5"},"reference-count":18,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Infection"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Secondary spontaneous pneumothorax (SSP), particularly when complicated by a persistent air leak, is an uncommon but serious manifestation of active pulmonary tuberculosis. Such cases often require pleural drainage or surgical intervention. Management becomes significantly more challenging when patients present with extensive pulmonary disease, compromised general condition, and severe comorbidities. We describe a 28-year-old male with bilateral extensive pulmonary tuberculosis, persistent right-sided pneumothorax, and a severe acute flare of chronic hepatitis B. Conventional management, including pleural drainage and chemical pleurodesis, was unsuccessful, and the patient\u2019s acute hepatic injury precluded the use of standard first-line anti-tuberculosis therapy. The primary clinical dilemma involved balancing the need for surgical repair of the persistent air fistula against the prohibitive perioperative risks posed by his hepatic dysfunction and poor systemic condition. A conservative, individualized medical strategy\u2014comprising modified anti-tuberculosis therapy, supplemental oxygen, nutritional optimization, and comprehensive liver support\u2014was selected. Over 6\u2009months, the patient demonstrated progressive improvement in hepatic function and overall physical status, substantial radiologic recovery of pulmonary lesions, and complete resolution of the right pneumothorax. This case highlights that a carefully tailored, conservative medical approach may yield favorable long-term outcomes in SPP secondary to pulmonary tuberculosis, particularly in patients with significant surgical contraindications. Optimizing anti-tuberculosis therapy remains central to promoting lung parenchymal healing and resolving pneumothorax.<\/jats:p>","DOI":"10.1177\/20499361261452939","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T06:34:36Z","timestamp":1781505276000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Secondary spontaneous pneumothorax due to extensive pulmonary tuberculosis in a patient with acute hepatitis B flare: clinical challenges and therapeutic decision making\u2014a case report"],"prefix":"10.1177","volume":"13","author":[{"given":"Loi","family":"Trinh Duc","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine, Military Hospital 175, Ho Chi Minh City, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bang Ngoc","family":"Dao","sequence":"additional","affiliation":[{"name":"Respiratory Center, Military Hospital 103, Vietnam Military Medical University, Hanoi, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3828-506X","authenticated-orcid":false,"given":"Cong","family":"Nguyen Hai","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine, Military Hospital 175, Ho Chi Minh City 72417, Vietnam"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,14]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.21037\/shc-23-5"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2016.10.73"},{"key":"e_1_3_4_4_2","unstructured":"World Health Organization WHO releases new global lists of high-burden countries for TB HIV-associated TB and drug-resistant TB https:\/\/www.who.int\/news\/item\/17-06-2021-who-releases-new-global-lists-of-high-burden-countries-for-tb-hiv-associated-tb-and-drug-resistant-tb (2021 accessed 30 October 2025)."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00128910"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.96.09102031"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.920393"},{"key":"e_1_3_4_8_2","article-title":"Tuberculous bronchopleural fistula: a rare and life-threatening disease","volume":"11","author":"Bathobakae L","year":"2023","unstructured":"Bathobakae L, et al. Tuberculous bronchopleural fistula: a rare and life-threatening disease. J Investig Med High Impact Case Rep 2023; 11; 23247096231220466.","journal-title":"J Investig Med High Impact Case Rep"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2005.038398"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11051173"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.7453\/gahmj.2013.008"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.119.2.590"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/thorax-2023-220304"},{"issue":"9","key":"e_1_3_4_14_2","article-title":"Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults","volume":"9","author":"Carson-Chahhoud KV","year":"2017","unstructured":"Carson-Chahhoud KV, et al. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults. Cochrane Database Syst Rev 2017; 9(9): CD004479.","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"e_1_3_4_15_2","article-title":"Tuberculosis presenting as spontaneous pneumothorax: a case report","volume":"17","author":"Bhanushali J","year":"2025","unstructured":"Bhanushali J, et al. Tuberculosis presenting as spontaneous pneumothorax: a case report. Cureus 2025; 17(1); e77927.","journal-title":"Cureus"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10173835"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.10.024"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003233421207"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.2007.056978"}],"container-title":["Therapeutic Advances in Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361261452939","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20499361261452939","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361261452939","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:16:38Z","timestamp":1781694998000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20499361261452939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":18,"alternative-id":["10.1177\/20499361261452939"],"URL":"https:\/\/doi.org\/10.1177\/20499361261452939","relation":{},"ISSN":["2049-9361","2049-937X"],"issn-type":[{"value":"2049-9361","type":"print"},{"value":"2049-937X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"article-number":"20499361261452939"}}