This case involved a 75-year-old woman. The patient was referred to our hospital for treatment of a prolonged pneumothorax with pleural effusion. We diagnosed her with a secondary spontaneous pneumothorax with pleuritis as a result of pulmonary Mycobacterium avium complex (MAC) infection. The pleuritis began adverse effects on the expansion of the lung, and the pneumothorax was not cured by drainage or thoracoscopic surgery. Therefore we decided to perform an endobronchial embolization with Endobronchial Watanabe Spigots. Air leakage from the lung stopped immediately after the procedure; however, the lung was unable to inflate anymore. The patient developed chronic respiratory failure complicated with pneumonia. She died one year and two months later. Because the prognosis of pulmonary MAC infection combined with pneumothorax and pleuritis is poor, it should be diagnosed and treated rapidly.