Lercanidipine-induced chylous ascites: Case report and literature review

Abstract

Calcium channel blockers should be considered as possible causes in cases of chyloperitoneum of unknown aetiology.

Calcium Channel Blocker-Related Chylous Ascites: A Systematic Review and Meta-Analysis

“…From January 1993 to December 2018, 13 articles [2,3,4,5,6,7,8,9,10,11,12,13,14] and 47 cases were found, and together with our one case, a total of 48 cases were included in the study. The available data revealed 22 males and 23 females (the sex of three patients was not known), with a median age of 50 years.…”

“…Chylous ascites is a condition in which white milky fluids rich in triglycerides (usually >200 mg/dL) accumulate in the abdominal cavity [2]. The characteristics of the ascitic fluid in chylous ascites include triglycerides >200 mg/dL, above the 500 leucocyte count, between 2.5 and 7.0 g/dL total protein, below 1.1 g/dL serum-ascites albumin gradient (elevated above 1.1 g/dL in chylous ascites secondary to cirrhosis), low total cholesterol (ascites/serum ratio <1), between 110 and 200 IU/L lactate dehydrogenase, positive culture in selected cases of tuberculosis, positive cytology in malignancy, elevated amylase in cases of pancreatitis, and below 100 mg/dL glucose.…”

“…(4) Increased lymphatic hydrostatic pressure—Basualdo et al proposed that lercanidipine blocks the voltage-gated calcium channels present in lymphatic vessel smooth cells, resulting in a lack of contractility [23]. This interferes with lymphatic drainage, generates vasodilation, increases the hydrostatic pressure in lymph vessels, and causes exudation of lymph through the walls of dilated retroperitoneal vessels [2]. (5) Ethnic background—our study found that 46 of 48 patients with CCB-related chylous ascites were Asian and only two were European.…”

“…Chylous ascites, which is defined as the accumulation of triglyceride-rich fluid in the peritoneal cavity, is an uncommon condition characterized by a white, milky-appearing peritoneal fluid and is related to disruption of the lymphatic system from any cause. Any source of lymphatic vessel obstruction or leakage can potentially cause chylous ascites [1,2], and it is generally associated with malignancies and surgical trauma [2]. There have been very few previous reports regarding chylous ascites arising secondary to administration of drugs [3].…”

Calcium Channel Blocker-Associated Chyloperitoneum in Patients Receiving Peritoneal Dialysis: A Systematic Review

“…Our systematic review showed that most of the studies indicated that CCB-associated chyloperitoneum developed within 4 days of initiation of CCB therapy and disappeared within 24 h of CCB withdrawal. In most cases, chyloperitoneum developed in patients who received their first CCB treatment, whereas some studies reported that chyloperitoneum developed after the CCB type prescribed to patients was changed [12] or when the dosage of the same drug was increased [26,42]. These findings indicated the timeline for medication review or monitoring of chyloperitoneum while PD patients are receiving pharmacotherapy.…”