Tuberculosis may be complicated with empyema and fistula in patients with cellular immune deficiency. The case presented was a 39-year-old male patient with diagnosis of rheumatoid arthritis developed hydropneumothorax while taking steroid and immunosuppressive treatment and examination of pleural fluid revealed acid-fast bacilli. The patient was admitted to the intensive care unit due to respiratory failure and underwent bronchoscopic examination due to air leakage. The right middle lobe was obliterated by using an endobronchial Watanabe Spigot (EWS), and the amount of leakage decreased considerably after the procedure. On day 7, chest tube drainage was removed, and empyema was drained with a Pezzer drain. On day 50, upon the cessation of empyema drainage, spigots were removed with rigid and flexible bronchoscope. In conclusion, EWS use in the treatment of bronchopleural fistula is an effective, safe and a reversible procedure.