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
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(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 (confirmed 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
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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)