Background: Dasatinib, a second-line tyrosine kinase inhibitor for chronic myeloid leukemia
(CML), is associated with pleural effusions but rarely causes chylothorax, with fewer than 20
reported cases.
Case Presentation: A 43-year-old female with CML in remission on Dasatinib presented with two weeks of progressive dyspnea, orthopnea, and intermittent cough. Imaging revealed a right pleural effusion. Thoracentesis yielded 1.5 L of chylous exudative fluid (triglycerides 1295 mg/dL, lymphocyte predominance), consistent with chylothorax. Infectious, cardiac, traumatic, and malignant causes were excluded through negative cultures, normal BNP, and unremarkable imaging. Dasatinib-induced chylothorax was diagnosed. The patient discontinued Dasatinib, transitioned to Nilotinib, and began dietary modification. Serial imaging showed resolution without recurrence at one-year follow-up.
Discussion: Chylothorax is defined as pleural fluid containing chyle due to thoracic duct disruption or impaired lymphatic drainage. Drug-induced chylothorax is rare; among tyrosine kinase inhibitors, Dasatinib has been implicated through inhibition of PDGF-β signaling and induction of endothelial permeability, resulting in lymphatic leakage. In this case, exclusion of alternative etiologies, temporal association with Dasatinib, and resolution upon discontinuation support causality.
Conclusion: Dasatinib-induced chylothorax is a rare but clinically significant adverse effect. Recognition is essential in patients on Dasatinib who present with unexplained respiratory symptoms. Diagnosis relies on pleural fluid analysis and exclusion of alternative causes. Management typically includes drug cessation, therapeutic thoracentesis, dietary therapy, and supportive care. Further reporting of such cases is critical to improving recognition, clarifying mechanisms, and guiding management of this rare complication.
Case Presentation: A 43-year-old female with CML in remission on Dasatinib presented with two weeks of progressive dyspnea, orthopnea, and intermittent cough. Imaging revealed a right pleural effusion. Thoracentesis yielded 1.5 L of chylous exudative fluid (triglycerides 1295 mg/dL, lymphocyte predominance), consistent with chylothorax. Infectious, cardiac, traumatic, and malignant causes were excluded through negative cultures, normal BNP, and unremarkable imaging. Dasatinib-induced chylothorax was diagnosed. The patient discontinued Dasatinib, transitioned to Nilotinib, and began dietary modification. Serial imaging showed resolution without recurrence at one-year follow-up.
Discussion: Chylothorax is defined as pleural fluid containing chyle due to thoracic duct disruption or impaired lymphatic drainage. Drug-induced chylothorax is rare; among tyrosine kinase inhibitors, Dasatinib has been implicated through inhibition of PDGF-β signaling and induction of endothelial permeability, resulting in lymphatic leakage. In this case, exclusion of alternative etiologies, temporal association with Dasatinib, and resolution upon discontinuation support causality.
Conclusion: Dasatinib-induced chylothorax is a rare but clinically significant adverse effect. Recognition is essential in patients on Dasatinib who present with unexplained respiratory symptoms. Diagnosis relies on pleural fluid analysis and exclusion of alternative causes. Management typically includes drug cessation, therapeutic thoracentesis, dietary therapy, and supportive care. Further reporting of such cases is critical to improving recognition, clarifying mechanisms, and guiding management of this rare complication.