Pleural effusion as a complication of newly diagnosed chronic lymphocytic leukemia

SESSION TITLE: Disorders of Pleura Case Report Posters 5 SESSION TYPE: Case Report Posters PRESENTED ON: 10/10/2023 09:40 am - 10:25 am INTRODUCTION: Pulmonary complications of chronic lymphocytic leukemia (CLL) rarely occur and are most commonly in the form of infectious complications related to chronic immunosuppression. There is a paucity of case reports of pleural effusions developing secondary to CLL published in the literature. The majority are associated with advanced disease or have occurred secondary to chemotherapy or radiotherapy. We present a case of a newly diagnosed CLL with an associated pleural effusion. CASE PRESENTATION: A 75-year-old female patient, with history of CLL diagnosed 10 days ago presented for evaluation of left-sided pleural effusion. Patient was experiencing progressively worsening dyspnea on exertion, orthopnea, and cough productive of clear sputum for 2 days. The patient was hemodynamically stable without requirement of oxygen supplementation. Physical examination was significant for decreased breath sounds of the left lung field with dullness to percussion. Chest computed tomography scan showed a moderate sized left pleural fluid collection with marked volume loss in the left lung. Thoracentesis was performed and around 1 L of cloudy dark, orange-colored fluid was sent for cytology and culture. Pleural fluid analysis was consistent with exudate fluid.Multiparametric flow cytometry analysis of pleural fluid detected clonal B lymphocytes that are positive for CD5, CD19, CD20 (heterogenous), CD22 (moderate), CD23, CD38 and CD45 and negative for CD10. Immunophenotype of the clonal B lymphocytes was similar to that observed previously on the peripheral blood and bone marrow biopsy flow cytometry. Patient's shortness of breath improved, and she was discharged the following day. She followed up with Hematology/Oncology and was started on acalabrutinib twice daily. The patient did not have recurrence of pleural effusion and did not have any repeat drainages or an indwelling pleural catheter. DISCUSSION: The incidence of pleural effusion in CLL patients is variable and depends on the stage of the disease and whether prior therapy was administered or not. Most patients who exhibit similar symptoms of pleural effusion are typically at a late-stage disease or have received various cancer-related treatments, rather than experiencing it as an early complication after initial diagnosis, as in our case. Malignant pleural effusion can occur in patients with CLL due to several reasons, including direct invasion of the pleura, compression of the lymphatics in the lung parenchyma, or compression of the thoracic duct. CONCLUSIONS: Regardless of the stage of the disease, CLL can be included in the differential diagnosis of possible causes of pleural effusion. REFERENCE #1: William Brasher, Saadia Faiz, Badar Patel, Lisa Torres, Alessandra Ferrajoli, Ala Eddin Sagar, Lara Bashoura, Carlos Jimenez, CHARACTERISTICS OF PLEURAL EFFUSIONS IN CHRONIC LYMPHOCYTIC LEUKEMIA, Chest, Volume 158, Issue 4, Supplement,2020,Page A1188,ISSN 0012-3692. https://doi.org/10.1016/j.chest.2020.08.1081 REFERENCE #2: Ahmed, S., Siddiqui, A.K., Rossoff, L., Sison, C.P. and Rai, K.R. (2003), Pulmonary complications in chronic lymphocytic leukemia. Cancer, 98: 1912-1917. https://doi.org/10.1002/cncr.11736 REFERENCE #3: E.Alkhankan, M Al Dliw, H Aswad, F. Alkhankan, Pleural Effusion as Unusual presentation of Chronic Lymphocytic Leukemia. May 1, 2017, A6670-A6670 DISCLOSURES: No relevant relationships by Isam Albaba No relevant relationships by Amit Chopra No relevant relationships by Omar Daghstani No relevant relationships by Marium Faiz No relevant relationships by Issam Halasa No relevant relationships by Ibrahim Khatim