Successful management of fistulous empyema caused by Mycobacterium avium complex in an advanced-age patient: A case report.

Herein, we report the case of an 87-year-old woman who presented with acute chest pain, fever, and cough. Imaging revealed a right pneumothorax, pleural effusion, and bronchiectasis. Pleural fluid was exudative with elevated adenosine deaminase levels, and Mycobacterium avium complex (MAC) was confirmed. Thoracoscopic plication and empyema cavity curettage were performed. Postoperatively, clarithromycin, rifampicin, ethambutol, and amikacin were initiated, leading to clinical improvement, smear and culture negativity, and discharge. Pleuritis caused by nontuberculous mycobacteria (NTM) is rare, occurring in only 1.4% of patients with NTM pulmonary disease; however, pneumothorax has been reported in 41% of these patients. NTM pleural disease with empyema is associated with a poor prognosis, with a 1-year mortality rate of 14-37%. In our report, early diagnosis enabled timely surgical and pharmacological intervention. This report highlights that even in advanced-age patients with preserved performance status, early multidisciplinary management may achieve favorable outcomes in MAC-associated pneumothorax and pleuritis.