Background <p>Bronchopleural fistula is a rare and severe condition characterized by an abnormal connection between the bronchial tree and pleural space, often leading to significant morbidity and mortality. Although typically resulting from surgical procedures, trauma, or pulmonary infections, bronchopleural fistula caused by smoke inhalation injury is exceptionally uncommon. Smoke inhalation can lead to extensive thermal and chemical damage to the respiratory tract, increasing the risk of infection and necrotic tissue changes that can complicate recovery.</p> Case presentation <p>We report a case of a 23-year-old white American male with a history of polysubstance use, who suffered extensive burn injuries and smoke inhalation following a propane explosion. Initial bronchoscopy revealed airway inflammation, erythema, and carbonaceous deposits. Despite treatment with antibiotics, the patient was readmitted with a persistent cough, productive foul-smelling sputum, and fever. Imaging and subsequent bronchoscopy revealed a right-sided bronchopleural fistula complicated by hydropneumothorax and empyema. Surgical intervention, including right lower lobectomy and intrapleural antibiotic therapy, was successful, leading to patient recovery and discharge with no recurrence at 1-month follow-up.</p> Conclusion <p>This case highlights a rare etiology of bronchopleural fistula due to smoke inhalation injury, emphasizing the need for prompt diagnosis and a multidisciplinary approach to manage this severe complication. Early imaging, bronchoscopic evaluation, appropriate antibiotic therapy, and surgical intervention are crucial for improved outcomes in bronchopleural fistula secondary to inhalation injuries.</p>