Infected chylothorax: a case report and review

Abstract

Infected chylothorax is a rare complication of a rare pathology with limited literature entirely consisting of case reports, meeting abstracts, and letters to the editor. The case of a 56-year-old male with a spontaneous infected chylothorax successfully treated and discharged to home without any residual effects is described. A systematic review of the literature revealed 11 prior cases of infected chylothoraces. Their etiologies (when known), initial pleural fluid values, and treatment are described. These cases show that while infected chylothorax has a varied presentation and affects a broad range of patients, conservative management including antibiotics, pleural fluid drainage, and symptomatic relief is a safe and appropriate starting point.

EEG Changes in Neonatal Hypoxic Ischemic Encephalopathy

“…According to development mile stone we found that patients were classified as having mild EEG feature all with normal development which has agreement with 14 , also 15 was shown that, infants with mild HIE with a continuous or to some extent discontinuous a EEG with lacking cyclicity are more likely to have Cont... 11 show agreement with our study by finding that, there are positive association between EEG background feature and severity of HIE, While 18 shown disagreement to our study in that all neonates were on hypoxic-ischemic encephalopathy (HIE) Stage I had normal EEG recording; 36.7% with HIE Stage II had abnormal EEG recording while had agreement to our study in that 100% of the neonates with HIE Stage III showed abnormal EEG. Explanation to this, the severity of encephalopathy in asphyxiated neonates correlates well with the abnormalities on EEG records.…”

October 2022 Medical Image of the Month: Infected Dasatinib Induced Chylothorax-The First Reported Case

“…This is the first reported case of infected chylothorax among the population using dasatinib. Infected chylothorax in general is rare, affecting wide variety of patients with different organisms and mostly benign course (2). In this report the patient was stable on presentation and showed good response to antibiotics, chest drainage, holding of dasatinib and dietary fat restriction.…”

“…It is a rare condition that may arise from diverse etiologies broadly categorized as traumatic or non-traumatic/spontaneous (1). Chylothorax is widely believed to be inherently bacteriostatic, with rare incidence of infected chylous effusions affecting a wide variety of patients with different causative organisms and a mostly benign course (2). Dasatinib is a second-generation tyrosine kinase inhibitor that is recommended as the first-line therapy for newly diagnosed chronic myeloid leukaemia (CML) or acute lymphoblastic leukaemia (ALL) with positive Philadelphia chromosome (Ph+) or as an alternative for the failure of prior therapy for CML.…”

Secondary infection of chylothorax with Serratia marcescens: a rare scenario post-cardiac surgery

“…The nature, color, and raised triglyceride levels of the pleural fluid confirm chylothorax [2,3]. Occasional reports of secondary infection of chyle by organisms such as Streptococcus agalactiae, Escherichia coli, and Acinetobacter calcoaceticus-baumanni in non-immunocompromised patients are published till date [6]. Loss of T lymphocytes in chyle causes immunodeficiency and makes the patient susceptible to infections [8].…”

“…It is also caused by non-traumatic causes and various malignancies and is occasionally spontaneous [2][3][4]. Chyle is considered bacteriostatic and infection in a chylothorax is thought not to occur [5,6]. Serratia marcescens harbors the gene AmpC which, if expressed, can cause the production of antibiotic destroying betalactamase enzymes making it multi-drug resistant.…”