Complications of enzymatic debridement in pulmonary tuberculosis with bronchopleural fistula.

The use of trypsin to digest the exudate of tuberculous and nontuberculous empyema has been reported by Roettig, Reiser, Habeeb and Mark’ as an effective means of preparing the patient for re-expansion of the lung, decortication, or pneumonectomy. On occasion, empyema has been sterilized of tubercle bacilli by this method. Our experience with enzymatic debridement in tuberculous patients with bronchopleural fistula and empyema has been unfortunate. Three cases are reported in which serious complications occurred as a direct result of this treatment. The effects of enzymatic therapy in six other cases will be summarIzed. Trypsin was employed in all cases. The combination of streptokinase and streptodornase with trypsin was used in a few of the treatments in three cases.