Tuberculosis-Associated Chylothorax: Case Report and Systematic Review of the Literature

Abstract

Tuberculosis (TB) is a rare cause of chylothorax. We describe a case and the results of a systematic review of all reported cases of TB-chylothorax. We identified 37 cases of TB-chylothorax. The symptoms at presentation were constitutional (85.7%; 30/35), dyspnea (60.6%; 20/33), and cough (54.5%; 18/33). Chylothorax developed subsequent to the diagnosis of TB in 27.8% (10/36) of the patients, after a median of 6.75 weeks (IQR 4–9). Chylothorax developed during an immune reconstitution syndrome (IRS) in 16.7% (10/36) of the patients, including immunocompetent ones. TB was disseminated in 45.9% (17/37) of the patients at the diagnosis of chylothorax. Chylothorax developed in the absence of any mediastinal lymphadenopathy in 45.9% (17/37) of the patients; 13.5% (5/37) had isolated tubercular empyema alone. The diagnosis of TB was established microbiologically in 72.2% (26/36) and by biopsy alone in 27.8% (9/36) of the patients. Anti-TB treatment (ATT) was administered for a median of 7.57 months (IQR 6–9). Steroids were administered to 22.9% (8/35) of the patients, often for suspected IRS. Thoracic duct ligation and octreotide were required for only 17.1% (6/35) and 8.6% (3/35) of the patients, respectively. In all, 94.4% (34/36) of the patients had resolution of chylothorax and completed treatment successfully; only 5.6% (2/36) died. In conclusion, TB-chylothorax may develop without obvious mediastinal lymphadenopathy and be associated with tubercular empyema alone. TB-chylothorax can develop during treatment of TB due to IRS, even in immunocompetent patients. ATT and dietary manipulation are associated with good resolution and low mortality, and duct ligation is needed for only a small minority of patients.

Reply to “Causes and manifestation of chylothorax in children”

“…In a case linked to tuberculosis, I agree with the comment that a pseudochylothorax should be considered, as tuberculosis is a common etiology of pseudochylothorax . However, it is rare but tuberculosis also developed chylothorax, which may be due to the obstruction of the thoracic duct by tuberculous lymphadenopathy with subsequent increase in pressure in the surrounding lymphatic system and leaking of chyle into the pleural space . The case in our study had chylothorax, chylous ascites and chylopericardium, the glucose was 5.12 mmol/L and presence of chylomicrons in pleural effusion.…”

Chylothorax with Transudate: An Unusual Presentation of Tuberculosis

“…The diagnosis of pleural tuberculosis was confirmed in 72.2% by culture or testing of sputum, pleural fluid or biopsy samples, with the rest identified by histopathology. The pathogenesis of the chylothorax was described as secondary to mediastinal lymphadenopathy in 51% of cases, followed by abdominal lymphadenopathy (14.3%) and extensive pleural disease (14.3%) [ 3 ] .…”

Bilateral secondary pulmonary tuberculosis complicated with bilateral chylothorax: a case report

“…Of the 35 patients who received treatment, only 6 received thoracic duct ligation, which may indicate that conservative treatment is the first choice when conservative treatment can control the disease. On the other hand, we believe that when conservative treatment can not control the disease, surgical intervention should be carried out as soon as possible (7). Chylothorax treatment guidelines suggest that regardless of whether chylothorax has a clear cause, the conservative treatment method should be applied initially, which usually consists of complete fasting, closed chest drainage, use of somatostatin octreotide, a non-fat diet, and complete parenteral nutrition (8).…”