Intrapleural Injection of Quinacrine for Pneumothorax in a Child With Cystic Fibrosis

Pneumothorax occurs in 2% to 4% of patients with cystic fibrosis following rupture of subpleural blebs into the pleural space. Death can occur, and recurrences have been reported. 1.2 Therapeutic procedures include needle aspiration, closed thoracotomy drainage, open thoracotomy with pleural scarification, or intrapleural instillation of irritants. When injected into the pleural space, the antimalarial drug quinacrine hydrochloride evokes an inflammatory response; the resultant fibrosis produces a tight adherence of the visceral and pleural surfaces. Quinacrine therapy for pneumothorax has been frequently used in adults, but there are few pediatric case reports. Report of a Case .—An 8-year-old boy diagnosed in infancy as having cystic fibrosis had developed hyperinflation, diffuse pulmonary fibrosis, and extensive bronchiectasis. He had pneumothorax and bronchopulmonary fistula for 44 days, which finally resolved following intrapleural injections of quinacrine. An episode of chest pain, progressive dyspnea, and cyanosis brought him to the hospital, where he was found