Hydropneumothorax as a Diagnostic Clue to Pulmonary Tuberculosis With Pleural Involvement: A Case Report.

Hydropneumothorax represents an unusual presentation of pulmonary tuberculosis (TB), posing diagnostic and therapeutic challenges. We report the case of a 36-year-old woman who presented with productive cough, dyspnea, right-sided pleuritic chest pain, and constitutional symptoms. Chest imaging revealed a large right-sided hydropneumothorax with extensive parenchymal and cavitary disease. Sputum smear microscopy was positive for acid-fast bacilli, and molecular testing of both sputum and pleural fluid detected Mycobacterium tuberculosis complex, confirming pulmonary TB with pleural involvement. Anti-TB therapy and chest tube drainage resulted in rapid and satisfactory re-expansion of the right lung. A small residual pneumothorax persisted after chest tube removal, without recurrence requiring further pleural drainage. This case highlights hydropneumothorax as an uncommon but clinically relevant manifestation of pulmonary TB and emphasizes the importance of considering TB in the differential diagnosis of spontaneous hydropneumothorax. Early recognition and appropriate management may contribute to favorable clinical outcomes.