A 50-Year-Old Man With Pleural Effusion and Chronic Myelogenous Leukemia

摘要

We report herein a case of a 50-year old man who was referred to the respiratory department with 4 months history of progressive dyspnea and dry cough. He was diagnosed to have chronic-phase Ph-positive chronic myelogenous leukemia(CML) 3 years ago and was treated with imatinib since then. Computerized tomography demonstrated a large right pleural effusion, a smaller left one and a small pericardial effusion. Diagnostic thoracentesis revealed an exudative pleural effusion according to the Light's criteria with predominantly lymphocytes. Patient's pleural effusion proved to be imatinib induced, since pleural fluid analysis excluded all obvious causes, discontinuation of the drug resulted in improvement and the patient did not have reaccumulation of his pleural effusion. Abbreviations ADA: adenosine deaminaseBP: blood pressureCEA: carcinoembryonic antigenCML: chronic myeloid leukemiaIFN-γ:interferon-gammaVEGF:vascular endothelial growth factorRT-PCR: reverse transcriptase polymerase chain reactionST1571: imatinib mesylate Case Report A 50-year old man was referred to the respiratory department with 4 months history of progressive dyspnea and dry cough. He was diagnosed to have chronic-phase Ph-positive chronic myelogenous leukemia(CML) 3 years ago. He was treated with imatinib 400mg and allopurinol 300mg daily. He used no other medication. Physical examinationThe patient was afebrile, with stable vital signs(pulse 83beats/min, respiratory rate 16 breaths/min, BP 130/95mmHg). Chest examination showed significantly diminished breath sounds in the right lung with dullness to percussion, the remainder of the physical examination was unremarkable. Laboratory and Radiographic FindingsThe white blood cell count was 9600 cells/mm3 with 67.9% neutrophils, 19.3% lymphocytes, 8.2% monocytes and 2.1% eosinophils. The haemoglobin was 13.6g/dl, haematocrit 40.5 g/dl, and platelet count 169.000 cells/mm3 . Blood chemistry was all within normal limits. A chest radiograph showed a right large pleural effusion(Fig 1). Spiral computerized tomography demonstrated a large right pleural effusion, a smaller left one and a small pericardial effusion. A diagnostic thoracentesis was performed which revealed straw colored fluid(Fig 2).