mikula peter department of clinical haematology hospital in havirov czech republic
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Mikula Peter
Department of Clinical Haematology
Hospital in Havirov
Czech Republic
Case history details
63- year-old man 2002 dg. B-CLL with typical immunophenotype
(Matutes 5/5), unmutated IgVH status, Binet B, large abdominal lymphadenopathy
10/02 – 3/03: 4 cycles of fludarabine-based treatment progressive dyspnoe, cough 2 weeks after the fourth
cycle of chemotherapy no fever, no chest pain physical examination – dyspnoe with tachypnoe,
absent breath sound in the lower half of the right hemithorax, normal blood pressure and pulse, normal heart examination, small peripheral lymphadenopathy, no hepatosplenomegaly, no edema
Case history details
Chest radiograph showed large right pleural effusion without significant mediastinal lymphadenopathy (confir-med by CT scan performed after the thoracocentesis)
Case history details
Laboratory values:• WBC 18000/ul (72% lymphocytes), haemoglobin
157g/l, platelet count 240000/ul• normal serum urea, creatinine, transaminases, alkaline
phosphatase, bilirubin, total protein and albumin levels
• slightly elevated CRP 17.9mg/l• reduced level of serum triglycerides at 0.31 mmol/l,
cholesterol level was normal• blood coagulation tests were normal
Case history details
Thoracocentesis was performed:• 1200 ml of milk-like fluid obtained• high amount of white blood cells in the fluid
(85% neoplastic lymphocytes)• relatively high total protein, normal LDH• elevated triglycerides 6.24 mmol/l, normal cholesterol
level – CHYLOTHORAX as a complication of B-CLL
Treatment received
recurrence of chylothorax a few days after thoracocentesis, thoracocentesis was repeated
progressive malnutrition total parenteral nutrition needed intrapleural application of cyclophosphamide not
effective intrapleural application of Corynebacterium parvum
not effective pneumology expert consultation –chemical
pleurodesis (talc) performed
Outcome
no recurence of chylothorax following talc pleurodesis fludarabine-based chemotherapy completed, total 6
cycles partial remission of B-CLL achieved 2003 – 2006 without progression of B-CLL 2006 death caused by renal carcinoma (secondary
malignancy)
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