Pyopneumothorax in an Alcoholic

We report the case of a 37-year-old man who presented after four days of developing left-sided chest pain, fever, and dyspnoea following an episode of vomiting. He was a chronic alcoholic. The chest X-ray revealed a left-sided hydropneumothorax. A chest tube was inserted which drained pus. A provisional diagnosis of left-sided pyothorax with iatrogenic pneumothorax was made. At this time, it was noticed that some liquid drained into the chest tube when the patient drank some water. A computed tomograph confirmed an oesophageal rupture. A diagnosis of Boerhaave’s syndrome was made. The patient survived thanks to an urgent surgical intervention. Physicians must consider and rapidly diagnose spontaneous oesophageal rupture in a patient presenting with pyothorax as it is a rapidly fatal condition.