Spontaneous bilateral chylothorax in a patient with epilepsy

This case report discusses a woman in her 30s presenting with an acute, rapidly progressive left anterior cervical swelling. While the neck swelling improved spontaneously, the patient subsequently developed large bilateral pleural effusions with respiratory failure requiring ventilatory support in the high dependency unit. Therapeutic thoracocentesis yielded chylous pleural fluid bilaterally. The respiratory failure subsequently improved and the patient was discharged home. This was an atypical presentation of chylothorax with no history of malignancy, atypical infection or apparent blunt trauma to the thoracic cage. The presence of bilateral chylothoraces suggested a multilevel thoracic duct injury. A significant tonic-clonic epileptic seizure, 6 days prior, is hypothesised as the potential underlying cause, which has not previously been reported in the literature.