Chylothorax: case report and review of literature

Chylothorax is a relatively uncommon condition. We report a case of a 53-year-old Chinese man with chylothorax who presented with cough, breathlessness, loss of weight and generalised lymphadenopathy. He was initially diagnosed as having tuberculosis based on histology and cultures of the cervical lymph node. However, immunophenotyping of the pleural fluid by flow cytometry showed the presence of a monoclonal B cell population with Kappa light chain expression suggesting an underlying lymphoproliferative disorder. A repeat lymph node biopsy showed malignant lymphoma (follicular small cleaved type). In spite of aggressive measures which included bilateral tube thoracostomy drainage, a low fat diet, medium chain triglyceride diet, total parenteral nutrition, chemotherapy and mediastinal irradiation, his chylothorax persisted. Hence, we report a patient with persistent chylothorax and generalised lymphadenopathy who was subsequently diagnosed to have concurrent tuberculosis and malignant lymphoma. The literature on chylothorax is reviewed.