Abstract: PUB121
Pleural Effusion: A Not So Sweet Hydrothorax
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Weinberg, Samuel, University of Minnesota Twin Cities, Minneapolis, Minnesota, United States
- Reule, Scott, Minnesota Department of Veterans Affairs, Saint Paul, Minnesota, United States
Introduction
Patient is a 68-year-old male. History is notable for ESKD on PD, type two diabetes, hypertension, and chronic myeloid leukemia (on dasatinib).
Case Description
He presented to the PD clinic with of shortness of breath and dyspnea on exertion. Chest x-ray showed a right pleural effusion (PE).
A CT peritoneography was done. Findings showed contrast throughout the peritoneal cavity and a small right PE without evidence of contrast in the thorax. The following day, a thoracentesis was performed. Initial pleural fluid analysis showed Glucose 148 mg/dL, protein 3.6 g/dL, LDH 311 U/L. Pleural fluid culture were negative. At the time of the thoracentesis, his serum glucose was 118 mg/dL, serum protein was 5.8 g/dL, and serum LDH was 183 U/L. Pleural fluid screened positive by Light’s criteria for an exudative fluid. Pleural fluid cytology was negative for malignancy. Following a negative work up for a pleuro-peritoneal fluid leak, his dasatinib was held.
Discussion
Dasatinib is a BCR-ABL tyrosine kinase inhibitor, used in patients with imatinib-resistant mutations. The incidence of PE in patients on dasatinib is 10-28%. Observational data suggests PE occurs in a dose-dependent manner. They typically develop during the first year of therapy, but some prospective studies show development at any time during treatment. Most cases can be managed with dose interruption or reduction and resolved within 4 weeks.
Pleuroperitoneal leak occurs in 1.6-2% of patients on PD. Characteristically, its a transudative effusion with low cell count, and elevated glucose. A glucose gradient of greater than 50 mg/dL has a 100% sensitivity and specificity for pleuro-peritoneal fistula in a patient on PD. Peritoneal scintigraphy or contrast CT peritoneography are typically also obtained to visually confirm. Treatment of pleuroperitoneal leak includes a PD holiday and small dwell volumes.