Reactions 1704, p133 - 2 Jun 2018 given unspecified diuretics. On 20 September 2015, a repeat chest CT scan revealed bilateral pleural effusions and pericardial effusion. On 29 September 2015, he underwent thoracentesis with intermittent drainage of the pleural fluid. Chylothorax: 3 case reports The yellowish chylous fluid was drained from both sides and In a study, 3 adult men [exact ages at the time of reaction tested positive for chyle. He was diagnosed with dasatinib- onset not stated], were described, who developed chylothorax associated grade 3 chylothorax and was treated with during treatment with dasatinib. octreotide and elemene. Subsequently, he started fasting and Case 1: A man in his 40s developed chylothorax during IV feeding. On 16 October 2015, he underwent thoracoscopy treatment with dasatinib. In April 2012, he was diagnosed with of low thoracic duct ligation at the right chest. However, no chronic myeloid leukaemia at the age of 47-year. significant improvement was observed as both sides of the Consequently, he started receiving treatment with imatinib. thoracic cavity still displayed massive amounts of chylous Subsequently, he developed severe eyelid oedema of an fluids. The dasatinib was restarted on 20 October 2015; unknown aetiology. In May 2013, his treatment switched to however, was discontinued again for 28 days. On oral dasatinib 100 mg/day. Eight months after the start of 5 November 2015, he was hospitalised for continuation of dasatinib, on 21 January 2014, a chest x-ray revealed right chylothorax treatment. Throughout the hospitalisation, he was pleural effusion, which was accompanied by gradual fasting and received parenteral feeding for 35 days. A repeat emergence of shortness of breath on exertion and productive CT scan displayed a significant decrease of the pleural effusion. cough. Subsequently, he underwent a closed thoracentesis After improvement of chylothorax symptoms, he was and the symptoms were relieved. However, on 22 April 2014, discharged. the pulmonary symptoms emerged again. Subsequent Author comment: This study reported 3 cases of laboratory investigation revealed WBC 5.94 x 10 /L, chylothorax induced by dasatinib treatment of [chronic haemoglobin (Hb) 127 g/L and platelet count 214 x 10 /L. A myeloid leukaemia], in order to raise awareness and increase chest CT demonstrated moderate volume of pleural effusion in the prevention of chylothorax during dasatinib treatment. the right lung with atelectasis of adjacent lung tissues. Subsequently, a closed thoracentesis was performed with a Yang L, et al. [Chylothorax Related with Dasatinib in the Treatment of Chronic total drainage of 900mL of chylous effusions. The pleural Myeloid Leukemia: Report of 3 cases]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 24: 1348-1353, No. 5, Oct 2016. Available from: URL: http://doi.org/10.7534/ effusion was found to be positive for chyle. He was diagnosed j.issn.1009-2137.2016.05.012 [Chinese; summarised from a translation] - with dasatinib-associated grade 2 chylothorax. He received China 803322829 symptomatic treatment with an unspecified potassium supplement and diuresis. The treatment with dasatinib was continued. The chylothorax symptoms were gradually alleviated. Case 2: A man in his 40s developed chylothorax during treatment with dasatinib. In February 2012, he was diagnosed with chronic myeloid leukaemia at the age of 46-year. Consequently, he started receiving treatment with imatinib. However, due to poor drug effect, his treatment was switched to oral dasatinib 100 mg/day in February 2014. In September 2015, 19 months after the start of dasatinib, he experienced chest tightness and shortness of breath. Subsequent thoracic ultrasound revealed massive pleural effusion in the left side, suspected to be secondary to dasatinib treatment. Therefore, dasatinib dose was reduced to 50 mg/day. He was treated with furosemide and spironolactone for diuresis. However, no significant improvement was observed after 15 days of dasatinib dose reduction. A chest ultrasound still displayed a massive pleural effusion on the left side with anteroposterior diameter of the deepest depth measured 10cm. Subsequently, dasatinib was withdrawn. On 16 November 2015, a thoracentesis was performed. The pleural effusion was found to be chylous and tested positive for chyle. A repeat ultrasound performed on 25 November 2015 revealed that the deepest depth of the pleural effusion on the left side was approximately 7cm. Consequently, he was diagnosed with dasatinib-associated grade 3 chylothorax. The thoracic duct was ligated. After ligation, the pleural fluid gradually decreased. Eventually, he was re-started on imatinib treatment. No further pulmonary symptoms were observed. Case 3: An adult man developed chylothorax during treatment with dasatinib. In January 2012, he was diagnosed with chronic myeloid leukaemia at the age of 49-year. He also had asthma. Consequently, he started receiving treatment with imatinib. However, due to failure to achieve optimum efficacy, his treatment was switched to oral dasatinib 100 mg/day in February 2013. On 30 August 2015, 26 months after the start of dasatinib, he experienced aggravation of pre- existing asthma along with shortness of breath. Subsequent chest and abdominal CT scans displayed pleural effusion, ascites and minimal pericardial effusion. A pleural fluid examination revealed rice soup colour, positive for mucin with triglyceride level of 11.91 mmoL/L and total cholesterol level of 1.43 mmol/L. Subsequently, dasatinib was withdrawn for 20 days. He underwent intermittent thoracentesis and was 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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