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Chylothorax in an elderly patient: case report An 80-year-old man developed chylothorax during concomitant treatment with diltiazem and simvastatin [routes not stated]. The man was hospitalised with a 3-day history of breathing difficulties and severe pain in his left chest, associated with a dry cough. His medical history was notable for hypertension treated with delayed-release diltiazem 300mg daily for the past 10 years, and hypercholesterolaemia treated with simvastatin 20mg daily for 7 years. Investigation revealed left-sided pleural effusion with a superficial polypnoea, extensive left pleurisy, and a milky fluid on thoracentesis. The pleural fluid was high in glucose and proteins, with total cholesterol and triglyceride levels of 0.86 and 3.46 g/L, respectively, confirming a chylous origin. He had anaemia, hypertriglyceridaemia, and an inflammatory biological syndrome. Treatment with α-amylase was initiated. The man was non-compliant with a fat-restricted diet and his course was marked by relapses requiring iterative tapping. Simvastatininduced chylothorax was suggested and the drug was later withdrawn. The effusion progressively resolved and followup at 6 months was unremarkable. Repeat chest x-ray was normal. Author comment: The role of simvastatin in the onset of chylothorax is plausible. The role of diltiazem is questionable . . . However, it may have played a potentiating role in the onset of chylothorax. Daix ATJ, et al. Simvastatin indused chylothorax. Revue de Pneumologie Clinique 68: 50-53, No. 1, Feb 2012. Available from: URL: http://dx.doi.org/10.1016/ j.pneumo.2011.06.008 [French; summarised from a translation] - Ivory 803069725 Coast

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Reactions 5 May 2012 No. 1400