A novel therapeutic strategy to close bronchopleural fistula related to Mycobacterium chelonae in elderly patients: two case reports and literature review

BACKGROUND: Mycobacterium chelonae (M. chelonae) empyema complicated with bronchopleural fistula (BPF) remains a significant challenge in diagnosis and treatment and the clinical outcomes are often unsatisfactory, especially in elderly patients. There is a paucity data related to the management of the condition. This is the first well-documented report of the therapeutic experience with bronchoscopic closure of a bronchopleural fistula with empyema related to M. chelonae infection in the elderly patients. CASE DESCRIPTION: An 86-year-old non-smoking male with a history of diabetes mellitus, emphysema, and bronchiectasis, and a 72-year-old non-smoking male with two past surgeries for lung cancer, both presented with chronic fever, purulent expectoration, hemoptysis, and dyspnea, and were diagnosed with bronchopleural fistula associated with M. chelonae infection. Long-term antibiotic regimens, prolonged thoracic drainage, and endoscopic closure with biological glue were all unsuccessful. The culprit bronchus was identified precisely with the combined assistance of the instillation of methylene blue and the Chartis digital air leak monitoring system. Bronchoscopic interventional therapy was successfully performed using the Zephyr one-way endobronchial valve or the Amplatzer patent ductus arteriosus occluder. Finally, two patients succeeded in removing chest tube, and were able to conduct daily activities. CONCLUSIONS: The successful bronchoscopic closure with the combined assistance of methylene blue and the Chartis digital air leak monitoring system provided valuable experience and novel strategy in dealing with BPF related to M. chelonae in the elderly and high-risk inoperable patients.