Extensive Pulmonary Tuberculosis Complicated by Pyopneumothorax in a Patient with Active Celiac Disease: A Management Challenge.

Tuberculosis (TB) remains a major global health concern, particularly among immunologically and nutritionally vulnerable individuals. Although celiac disease (CD) has been associated with an increased risk of TB, extensive and complicated forms remain rarely reported. We report the case of a 27-year-old man with CD, poor adherence to a gluten-free- diet (GFD), schizophrenia, and substance use disorders, who presented with extensive cavitary pulmonary TB (PT) complicated by pyopneumothorax and severe undernutrition. Concerns were raised regarding anti-TB drug absorption. In the absence of injectable anti-TB agents, standard oral treatment was initiated alongside a strict GFD, nutritional rehabilitation, and cessation of substance use. The patient showed very gradual general health improvement and required prolonged chest drainage, ultimately resulting in clinical recovery with residual pleuroparenchymal sequelae. This case highlights that PT in active CD can achieve recovery with oral anti-TB therapy when associated malabsorption is strictly managed.