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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 (Matutes 5/5), unmutated IgVH status, Binet B, large abdominal lymphadenopathy

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Mikula Peter

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Mikula Peter

Department of Clinical Haematology

Hospital in Havirov

Czech Republic


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Case history details

  • 63- year-old man

  • 2002 dg. B-CLL with typical immunophenotype (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


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Case history details

  • Chest radiograph showed large right pleural effusion without significant mediastinal lymphadenopathy (confir-med by CT scan performed after the thoracocentesis)


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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


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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


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Treatment received

  • recurrence of chylothorax a few days after 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


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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)


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