RESUMEN
We describe a case of chylothorax of idiopathic etiology, treated with octreotide, a long-acting somatostatin analogue. A 30-year-old man with a left supraclavicular mass, and chylothorax, initially diagnosed by outpatient thoracentesis, underwent diagnostic surgery to ascertain the etiology of the pleural effusion. Biopsies of the left supraclavicular mass, lymphatic tissue and lymph nodes were benign. Triglyceride level in the pleural fluid was 396 mg/dL, diagnostic of chylothorax. Treatment included intravenous total parenteral nutrition (TPN) and a nil per os (NPO) diet. Subsequent surgical interventions included left lung decortication and glue-mediated control of chylothorax, combined with TPN and a strict low-fat diet. Given the persistency of chylothorax, thoracic duct ligation was also performed, and octreotide subcutaneous injections were started, with dramatic resolution of pleural effusion, after 1 week of treatment, in absence of any side effects. The patient fully recovered, and no relapse has been observed during a follow-up period of over 1 year. In conclusion, octreotide showed to be a valid and safe noninvasive approach for the treatment of chylothorax, whose early clinical use may also reduce the need for surgical intervention.
Asunto(s)
Quilotórax/tratamiento farmacológico , Octreótido/uso terapéutico , Somatostatina/análogos & derivados , Adulto , Quilotórax/etiología , Humanos , MasculinoRESUMEN
An Ethiopian immigrated to Israel and gave a positive test result for human immunodeficiency virus. Soon after, he was thrice admitted to hospital in 3 months for severe pneumonia. Acquired immunodeficiency syndrome was diagnosed, as was hyperreactive malarial splenomegaly (HMS). Thereafter, during maintained proguanil treatment for HMS, the patient remained well for 16 months. Then, after another pneumonic illness, pneumococcal vaccine was administered. Proguanil was maintained for another 10 months and, despite declining CD4 cell counts, good health continued for a further 18 months.