BILATERAL CHYLOTHORAX AND ANASARCA CAUSED BY DASATINIB IN A PATIENT WITH CHRONIC MYELOGENOUS LEUKEMIA

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Dasatinib is one tyrosine kinase inhibitors that used in treatment for Philadelphia positive Chronic Myeloid Leukemia (CML). Pleural effusion can occur 10% patients on dasatinib, but chylothorax was rarely reported as a side effect dasatinib (1,2). CASE PRESENTATION: A 52 year-old male with medical history CML presented shortness breath over past 4months. Patient diagnosed 10 years ago. Initially he started imatinib which did not tolerate secondary to headache and switched 100mg daily tolerated 5 years. Bone marrow biopsy showed complete cytogenetic remission 6-months achieved major molecular remission. Physical exam remarkable reduced air entry both lungs, abdominal ascites, lower extremities pitting edema up groins. Basic labs were within normal limits. Chest X-ray bilateral pleural effusions confluent bibasilar infiltrates. Computed topography chest large passive atelectasis lobes (figure-1A 1B). CT scan abdomen pelvis diffuse body extending extremities. Large right hydrocele moderate left also noticed (figure-1C). Imaging guided thoracentesis performed 1900 ml milky fluid drained. analysis total protein 4.6 g/dL (serum protein:7.3 g/dL), glucose 97 mg/dL glucose: 84 mg/dL), elevated lactate dehydrogenase (116 U/L), triglyceride (485 cholesterol (83 mg/dL). Based that, Diagnosis made discontinued. short course diuretics oral prednisone. After month discontinuation, SOB improved significantly. Abdominal swelling has too. Repeated CXR (figure-1D). We kept patient off monthly check BCR/ABL by PCR plan restart at 50 mg or switching another if relapses. DISCUSSION: known few reports unilateral have been reported. Bilateral anasarca are very rare effects dasatinib. In most cases, discontinuation improve symptoms. previous case report, 63 female sided induced totally resolved after nilotinib (2). 71 initially then recurred re-initiation dasatininb (3). CONCLUSIONS: rare. Most cases resolve completely discontinuation. REFERENCE #1: Kantarjian H, Shah NP, Hochhaus A, et al. versus newly chronic-phase chronic myeloid leukemia. N Engl J Med. 2010 Jun 17;362(24):2260-70. doi: 10.1056/NEJMoa1002315. Epub 5. PMID: 20525995. #2: Al-Abcha Iftikhar MH, Abu Rous F, Chylothorax: complication attributed use. BMJ Rep. 2019 Dec 16;12(12):e231653. 10.1136/bcr-2019-231653. 31848139; PMCID: PMC6936595. #3: Chen B, Wu Z, Wang Q, Dasatinib-induced chylothorax: report review literature. Invest New Drugs. 2020 Oct;38(5):1627-1632. 10.1007/s10637-020-00932-3. Apr 4. 32248338. DISCLOSURES: No relevant relationships hamed daw, source=Web Response Christopher Haddad, Tariq Kewan, Talha Saleem,