Gastropleural fistula masquerading as chylothorax in a child with lymphoma

Abstract

We report the case of an 8-year-old boy with diffuse large B cell lymphoma who developed a right-sided spontaneous pneumothorax with pleural effusion after recovery from septic shock. The pleural fluid was thought to be malignancy-associated chylothorax concomitant with complicated pleural effusion due to a milky-like appearance, a high level of triglycerides and Gram-negative bacteria staining in the fluid. He was put on total parental nutrition and octreotide for 2 weeks, but did not improve. The laboratory results also showed a persistent bacterial infection in the pleural fluid despite appropriate antibiotics. Eventually, a CT scan revealed a fistulous tract between the right pleural cavity and the stomach. Fistula repair was successful by right open thoracotomy with decortication. Even though the gastropleural fistula is a very rare condition in paediatric patients, the physician should consider this diagnosis in a patient who has an unusual presentation or refractory chylothorax-like pleural effusion.

Non-operative Management of Spontaneous Gastropleural Fistula Caused by Primary Gastric Diffuse Large B-cell Lymphoma

“…To our knowledge, only four patients with malignant lymphoma-related GPF have been reported. Two of them developed GPF spontaneously (7,14), while the others devel- (11).…”

“…Malignancy-associated GPFs have a particularly poor prognosis. A previous study pointed out that almost 90% of malignancy-related GPF patients died or needed palliative care, even though the initial GPF was successfully closed ( 12 ).…”

“…To our knowledge, only four patients with malignant lymphoma-related GPF have been reported. Two of them developed GPF spontaneously ( 7 , 14 ), while the others developed it during or after chemotherapy ( 12 , 15 ). Patients with spontaneous GPF are listed in Table .…”

“…The other patient was an eight-year-old boy with DLBCL complicated with chylothorax. He underwent right open thoracotomy, right pleural decortication, and eight-course chemotherapy, subsequently achieving a complete clinical response ( 12 ).…”