CHYLOTHORAX: SECONDARY COMPLICATION TO THE USE OF DASATINIB

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: A 50-year-old man, with a medical history of Chronic Myeloid Leukemia, in relapse treated dasatinib. Who presents dyspnea and non-productive cough. Chest x-ray shows left pleural effusion. Diagnostic thoracentesis was performed 150 ml fluid extracted. sample sent for analysis, which compatible chylothorax. Significant improvement observed after thoracentesis. In the absence any other diagnostic alternative, effusion attributed to use CASE PRESENTATION: diagnosed 4 years ago, currently relapse, He has not had hospital admissions last year. this admission, he presented cough without predominance schedule. The emergency department does require supplemental oxygen. physical examination notable decrease vesicular murmur lung. DISCUSSION: Upon laboratory analysis revealed hematology electrolytes normal limits. X-ray (Fig. 1) showed effusion, it complemented chest tomography 2). There no evidence pulmonary or mediastinal lesions, lymphadenopathy. Thoracentesis performed, Pleural triglycerides: 644.72, cholesterol: 59. White blood cells total count was, PMN: 1.2%, Mononuclear 98, micro proteins: 624 mg / dl, LDH: 105.9. Cytology negative malignant cells. CONCLUSIONS: Dasatinib is tyrosine kinase inhibitor drug, approved treatment chronic myeloid leukemia. most common adverse effect; an incidence 7 - 40% cases. usually predominantly lymphocytic exudate, but may occasionally present as Chylothorax rarely been documented, grade variable, pathophysiology entirely clear. Triglyceride concentration greater than 110 dl supports diagnosis. case 600 dl. current on relationship CML chylothorax, causes type chylothorax are tuberculosis, lymphoma, empyema biliopleural fistula. Associated infections were ruled out, Obtaining cultures, there lesions masses associated risk factor, its characteristics drug. Treatment consisted reducing dose until therapeutic thoracentesis, favorable clinical evolution. REFERENCE #1: Trivedi PC, Hapangama S, Perez Batista E, et al. induced American Journal Respiratory Critical Care Medicine 2017; 195: A3479. #2: Bergeron A, Réa D, Levy V, Picard C, Meignin Tamburini J, Pulmonary abnormalities dasatinib leukemia: series. Am J Respir Crit Med. 2007; 176: 814–8. #3: Ferreiro L, San-José Suárez-Antelo Dasatinib-induced effusion: option consider. Ann Thorac Med 2016; 11: 289. DISCLOSURES: No relevant relationships by Jose Aguilar, source=Web Response Jorge Luis Aguilar Castellanos, disclosure file José Waldemar Castillo; MARIA EUGENIA CHOC DE AJANEL, Cifuentes, Gabriel Rios, angel soto