• rifampicin
• pneumonitis
• bronchopleural fistula
• tuberculosis

We read with great interest the article by Kunichika et al which describes a probable case of pneumonitis induced by rifampicin.¹ However, we think that the case needs further clarification.

We note that on admission the chest radiograph did not show a simple left pleural effusion but an air-fluid level, suggestive of a bronchopleural fistula. A bronchopleural fistula associated with tuberculosis usually follows trauma or a surgical procedure, but it can also occur spontaneously in patients with longstanding tuberculous empyema because the tuberculous process establishes an open pathway between the bronchus and pleura. Tuberculous empyema may be present for a long time with few clinical symptoms, and patients may come to clinical attention only when undergoing a routine chest radiograph or after a bronchopleural fistula or empyema develops.² The chest radiograph on admission also showed a thickened pleura and loss of volume of the left lung, suggesting longstanding pleural disease. The authors do not specify the characteristics of the pleural fluid of the patient.

In the chest radiograph taken on day 9 we think that the shadows in the …