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)