CRA48 CHALLENGES IN DIAGNOSING AND MANAGING BILATERAL CHYLOTHORAX IN HODGKIN LYMPHOMA; RE-EVALUATING TB DIAGNOSIS

Nor Safiqah Sharil1, Nazleen Zulkifli2, Boon Hau Ng2, Nik Nuratiqah Nik Abeed2, Andrea Ban Yu-Lin2
1 Internal Medicine Unit, Faculty of Medicine and Health Science, University Sains Islam Malaysia, Negeri Sembilan, Malaysia
2 Faculty of Medicine, University Kebangsaan Malaysia

Introduction

The presentation of bilateral chylothorax in Hodgkin Lymphoma (HL) is exceptionally rare and poses significant diagnostic and management challenges. This abstract details a case highlighting the importance of re-evaluating tuberculosis (TB) diagnoses in patients unresponsive to standard treatment and the complexities of managing chylothorax.

Case Description

A 46-year-old woman initially presented with a right supraclavicular mass and was treated for TB lymphadenitis. Despite anti-TB therapy, the mass increased in size. Multiple biopsies were inconclusive until a CT-guided biopsy confirmed classical HL, nodular sclerosis subtype. Upon presentation to our center, the patient exhibited severe dyspnea, significant weight loss, and bilateral pleural effusions. Pleural fluid analysis confirmed chylothorax, characterized by high triglyceride levels and low cholesterol. The patient underwent pleural drainage and dietary modifications, including a medium-chain triglyceride diet. Initial chemotherapy with the BEACOPP regimen yielded a partial response, but recurrent infections necessitated a switch to the ABVD regimen. Subsequent PET-CT scans showed complete metabolic response and resolution of the bilateral pleural effusion.

Conclusion

This case underscores the critical need to re-evaluate TB diagnoses when patients do not respond to treatment, as delayed diagnosis of HL can lead to advanced disease and complications. The management of chylothorax in HL is particularly challenging due to the rarity of the condition and the need for a multimodal approach. Effective management requires prompt pleural drainage, dietary modifications, and tailored chemotherapy regimens.