Dasatinib
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Dasatinib Pleural effusion and chylothorax: case report
A 63-year-old woman developed pleural effusion and chylothorax during treatment with dasatinib for chronic myeloid leukaemia. The woman was admitted to the emergency room with a 2-month history of progressive symptoms comprising dyspnoea on exertion and in left lateral decubitus position without fever, chest pain or constitutional syndrome. She had been receiving oral dasatinib 100 mg/day for one year to treat chronic myeloid leukaemia. Decreased vesicular murmur in the left lower field with signs of pleural effusion were noted upon pulmonary auscultation. Thorax X-ray showed left pleural effusion in the lower third, with normal cardiac silhouette. Blood test showed leucocyte count 5900 with 54% neutrophils, 25.4% lymphocytes, 7.2% eosinophils, haemoglobin of 12.8 g/dL, mean corpuscular volume of 90.6, platelet count 2 42 000 and ESR of 34mm [not all units stated]. Biochemistry, autoimmunity study and immunoglobulins were normal. Thoracentesis revealed a milky pleural fluid (PF) with glucose 90 mg/dL, albumin 2.30 g/dL, LDH 152 U/L, protein 5.05 g/dL, cholesterol 106 mg/dL, triglycerides 334 mg/dL, carcinoembryonic antigen 1.2 ng/mL, rheumatoid factor < 10 IU/mL, negative ANA, leucocytes 1470 /mm3, RBC count 3000 /mm3, mononuclear 98.8% and polynuclear 1.2%. Cytology showed lymphoid-predominant reactive cytoarchitecture with some elements of myeloid ontogeny with no evidence of malignancy. The bacterial culture and Lowenstein were negative. Pleural biopsy revealed mesothelial hyperplasia. The echocardiogram was normal. Therefore, a diagnosis of pleural effusion and chylothorax secondary to dasatinib was made [duration of treatment to reaction onsets not stated]. The woman’s treatment with dasatinib was switched to imatinib, and she was started on prednisone therapy. A thoracic drainage was perforemed. Later, she was discharged. After 10 days of the discharge, a thoracic computed axial tomography showed organised left-sided pleural effusion. A new thoracentesis showed amber pleural effusion with pH 7.55, glucose 148 mg/dL, LDH 169 U/L, cholesterol 120 mg/dL, triglycerides 81 mg/dL, protein 5.32 g/dL, leucocytes 2874 /mm3, polynuclear 31.8%, mononuclear 68.2% and RBC count 5000 /mm3. Subsequently, her pleural effusion resolved [not all outcomes stated]. Molina V, et al. Chylothorax Secondary to Dasatinib. Archivos de Bronconeumologia 56: 599-601, No. 9, Sep 2020. Available from: URL: http://doi.org/10.1016/ j.arbres.2020.05.001 [Spanish; summarised from a translation]
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Reactions 10 Oct 2020 No. 1825
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