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Case Report
Bilateral chylous effusions as a complication of advanced chronic lymphocytic leukemia
1 Resident, Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
2 Oncologist, Department of Hematology-Oncology, University of Miami Health, Miami, FL, USA
3 Pathologist, Department of Pathology, Mount Sinai Medical Center, Miami, FL, USA
4 Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
Address correspondence to:
Megan Winter
4300 Alton Road, Miami Beach, FL,
USA
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Article ID: 100072Z10MW2020
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Winter M, Rodriguez E, Poppiti R. Bilateral chylous effusions as a complication of advanced chronic lymphocytic leukemia. J Case Rep Images Oncology 2020;6:100072Z10MW2020.ABSTRACT
Introduction: A chylous effusion, or chylothorax, is a collection of milky fluid consisting of emulsified fats that has accumulated in the pleural space due to extravasation from lymphatic vessels, mainly the thoracic duct. There are three main etiologies of chylothorax—traumatic, non-traumatic, and idiopathic. Non-traumatic chylothorax is typically associated with malignancy, though an association with chronic lymphocytic leukemia (CLL) is very rarely seen or reported.
Case Report: A 92-year-old woman with atrial fibrillation and CLL presented to the cancer center with the complaint of worsening shortness of breath exacerbated by exertion. Her symptoms were associated with orthopnea, paroxysmal nocturnal dyspnea, and bilateral swelling in her lower extremities. She was hospitalized and found to have a pleural effusion, believed to be due to congestive heart failure. Despite therapy with diuretics, her symptoms persisted requiring thoracentesis. It was at this time that the fluid analysis revealed a triglyceride count consistent with chylothorax. Her history was inconsistent with any common etiology for the development of chylothorax, without a history of recent surgery, recent trauma, or solid tumors. This raised suspicion that her CLL may be the cause. Less than a month later, her CLL relapsed as she exhibited worsening adenopathy and a leukocyte count that had more than doubled. She was started on steroids, venetoclax, and underwent repeat thoracentesis, ultimately requiring invasive treatment. However, she expired shortly after initiation of therapy.
Conclusion: Chronic lymphocytic leukemia has rarely been associated with the development of chylothorax for reasons that are not fully understood. It is important for clinicians to consider chylothorax in the differential diagnosis of patients with CLL presenting with shortness of breath and pleural effusion in order to guide suitable therapy, which may include adjustment of or additional chemotherapy.
Keywords: Chronic lymphocytic leukemia, Chylothorax, Chylous effusion
SUPPORTING INFORMATION
Author Contributions
Estelamari Rodriguez - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Megan Winter - Substantial contributions to conception and design, Acquisition of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Robert Poppiti - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2020 Megan Winter et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
