Chylothorax in Uncommon Contexts: Pulmonary Tuberculosis and Mantle Cell Lymphoma.

Abstract

Chylothorax, characterised by the accumulation of chyle in the pleural space, is a rare yet clinically significant condition. This lymphatic fluid, rich in fats absorbed from the intestine, can be caused by various factors including trauma, malignancy, and tuberculosis (TB). Traumatic causes, particularly iatrogenic procedures, account for a significant proportion of cases, followed by rare etiologies like malignancies such as lymphoma, and less commonly, tuberculosis. In the first two cases, the patient was diagnosed with tuberculosis during evaluation for chylothorax; however, in the third case, the patient developed chylothorax as a complication of mantle cell lymphoma (MCL). Two male patients, aged 43 and 45, presented with respiratory symptoms and milky pleural effusions (triglycerides > 180 mg/dL). In both, bronchoalveolar lavage confirmed rifampicin-sensitive TB. Both patients responded to anti-tubercular therapy and dietary modification. A 69-year-old male with a history of non-Hodgkin's lymphoma developed chylothorax (triglycerides 286 mg/dL) and lymphadenopathy; imaging and biopsy confirmed MCL. He responded to chemotherapy. This series underscores the importance of considering uncommon causes of chylothorax during evaluation and tailoring treatment based on specific etiologies.