Dasatinib-induced chylothorax in a patient with chronic myeloid leukemia

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Case description

We present a case of a 49-year-old man with a 3-year history of chronic myeloid leukemia (CML). Presence of the BCR/ABL p210 transcript was detected on molecular testing and Philadelphia chromosome positivity was confirmed on flow cytometry. The patient was treated with dasatinib, which resulted in complete remission of CML. He also presented with mild hypercholesterolemia.

After 2.5 years of dasatinib use, the patient developed a dry cough, weight loss, and exertional dyspnea. Computed tomography scan of the chest showed moderate bilateral pleural effu¬sion. Echocardiography was normal.

Two months later, progression of the effusion was observed, prompting drainage via a right pleural drainage tube, yielding 1200 mL of milky fluid. Pleural fluid analysis was compatible with chylothorax. The patient had no history of possible causes of chylothorax such as trauma, thoracic surgery, or malignant thoracic lesions, leading to suspicion of dasatinib-induced chylothorax. Therefore, dasatinib was discontinued and imatinib 400 mg per day was initiated.

During the 16 days of hospitalization, a diet based on light-chain fatty acids was prescribed and during that time pleural drainage gradually decreased without complications. The patient was discharged with pleural drainage still in place. In outpatient follow-ups, there was a gradual decrease in pleural drainage to values below 100 mL every 24 hours and after 4 months the pleural drainage tube was removed. Two months after pleural drainage removal, no recurrence was observed.

About Best Case Report Contest 2024

Young Talents in Internal Medicine World Contest—previously Best Case Report Contest—is a contest for internal medicine specialists or trainees in internal medicine up to 35 years of age. Every year the most engaging submissions from around the world are presented by authors during a special session at the McMaster International Review Conference of Internal Medicine (MIRCIM). Visit youngtalents.one to learn more.

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