Tuberculosis Associated Chylothorax
J. Alfredo Santibáñez-Salgado, Sr., Tom Tarque Takeichi, Francina V. Bolaños-Morales, Patricio J. Santillán-Doherty.
National Institute of Respiratory Diseases., Tlalpan, CDMX, Mexico.
Tuberculosis (TB) is a public health problem in Mexico, since 21184 cases were reported in 2016.Tuberculosis-associated chylothorax is rarely seen. There are 37 cases reported in world literature. Th mechanism of development, clinical features, radiological findings, diagnosis and management are unclear.We present a 22 years old man who developed chylothorax associated to TB. Case Presentation:A 22 y.o. male presented with mild dyspnea, productive cough, 20 kg weight loss, night sweats and hyperthermia for 3 months. In the emergency room presented dyspnea, arterial pressure 80/50 mmHg, pulse oximetry 80%. The CXR showed left-sided pleural effusion. Diagnostic thoracentesis yielded pus-like material. An intercostal chest tube drain was inserted. Pleural decortication and drainage was performed via VATS. Three hundred ml of heavy pus-like material was found. Mycobacterium tubercoulosis was reported from the pus-like material. Anti TB treatment was started. Two weeks later, the chest tube drain showed milky material, and diagnosis was chylothorax. He was treated with TPN, and doTBAL. The chylothorax remitted on the third treatment day. After that, the chest tube was retired and the clinical evolution was uneventful.ConclusionThis is a rare case of late post VATS associated-tuberculosis chylothorax, since it appeared two weeks after pleural empyema managed by VATS. The physiopathological development of TB chylothorax is unclear, but we can hypothyse it was due to direct involvement of the pleura and or lymphatic ducts due to TH or host-immune response during anti TB treatment.
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