Dasatinib-Induced Bilateral Pleural Effusions

Abstract

Fluid accumulation in the form of pleural effusions and ascites may be attributed to a single etiology. Diagnosis depends on a thorough clinical history as well as fluid analysis. We present the case of a 60-year-old man with chronic myeloid leukemia (CML) on dasatinib, recent right-sided ischemic stroke, alcohol-associated liver disease, cocaine and alcohol use disorders in early remission, and hypertension who presented with subacute-onset of bilateral pleural effusions and ascites. Pleural fluid analysis showed an exudative effusion, while ascitic fluid analysis showed a transudative collection. After an extensive workup, the bilateral effusions were attributed to dasatinib therapy, which was also suspected to play an unclear role in the worsening ascites. Although peripheral edema and pleural effusions are well-recognized and common side effects of tyrosine kinase inhibitors (TKIs), this case represents the first description of a patient presenting with bilateral TKI-induced pleural effusions as well as concomitant ascites of unclear origin.

Keywords: bilateral; chronic myeloid leukemia; dasatinib; pleural effusions; treatment.

Figure 1. Posteroanterior chest radiograph on admission showing congestive changes, left-sided pleural effusion (arrow), and basilar underaeration.

Figure 2. Post-paracentesis abdominal CT showing residual ascites (black arrow) and free air (white arrow), likely post-procedural. The presence of nodular liver contour indicative of cirrhosis, splenomegaly, as well as small gastroesophageal varices.

Figure 3. Pre-thoracentesis chest CT showing moderate bilateral opacities (arrows) with mild patchy opacity and bronchiectasis in the right upper lobe, potentially scarring or fibrosis.