Dasatinib-Induced Bilateral Chylothorax: A Case Report

Abstract

Dasatinib, a BCR-ABL tyrosine kinase inhibitor, is used in the management of Philadelphia-positive chronic myeloid leukemia (CML). Several adverse complications of this targeted immunotherapy have been reported. This case report focuses on a 79-year-old female who presented with acute dyspnea and generalized chest pressure while undergoing management with this specific tyrosine kinase inhibitor. Bilateral chylothorax was diagnosed with the aid of imaging, laboratory studies, and diagnostic thoracentesis. No other risk factors, including trauma, lung malignancies, or congenital anomalies, were detected in this patient. Since no other etiologies for the development of chylothorax were identified, it was concluded that dasatinib therapy was the inciting factor. Dasatinib was discontinued and bosutinib was initiated. A low-fat diet was prescribed, which the patient was amenable to. Six months later, the patient remained stable with no recurrence of chylothorax. The mechanism of dasatinib-induced chylothorax is currently under investigation. The purpose of this report is to raise awareness about dasatinib-induced chylothorax, aid in identifying predisposing risk factors, and enhance understanding of the proper management of this rare complication.

Keywords: #dasatinib; acute dyspnea; bcr-abl positive; bilateral chylothorax; bilateral pleural effusion; chronic myeloid leukemia (cml); exudative pleural effusion; philadelphia chromosome positive.

Figure 1. Electrocardiogram at initial presentation

The image shows sinus rhythm with right bundle branch block and left axis deviation. No QT prolongation; no STEMI STEMI: ST-segment elevation myocardial infarction

Figure 2. CT chest angiogram

Arrows 1 and 2 show bilateral pleural effusions. No pulmonary embolism was visualized CT: computed tomography

Figure 3. Chest radiograph on initial presentation identifying bilateral pleural effusions

Arrows 1 and 2 display left and right pleural effusions, respectively. No pneumothorax was visualized

Figure 4. Chest radiograph following thoracentesis

Resolved bilateral pleural effusions after diagnostic and therapeutic thoracentesis for the evaluation of pleural fluid