A70-43 Tuberculosis Associated Chylothorax

Abstract Chylothorax is an abnormal collection of lymphatic fluid in the pleural space caused by either obstruction or disruption of the thoracic duct. This is most commonly associated with traumatic or malignant aetiologies, but more rarely can be caused by infections including tuberculosis. We present the case of a 27 year old Somalian gentleman who presented to the emergency department with a subacute history of shortness of breath and chest pain. Chest radiograph and subsequent computed tomography revealed a large left sided pleural effusion with associated bulky mediastinal lymphadenopathy. A chest drain was inserted with over 3 litres of pleural fluid drained before removal. Transbronchial needle aspiration of his mediational nodes showed necrotising granulomas and Nucleic Acid Amplification Testing (NAAT) confirmed Mycobacterium tuberculosis DNA on lymph node aspirate and sputum. He completed 7 months of RIPE treatment for pan-sensitive tuberculosis under directly observed therapy. He had a persistent moderate sized pleural effusion which remained stable for nine months post treatment before he represented with worsening dyspnoea and an enlarging effusion. A chest drain was inserted, draining milky coloured pleural fluid with elevated triglycerides. Lymphoscintigraphy confirmed a lymphatic leak with the passage of tracer into the pleural space at the level of the mid aortic arch. He was diagnosed with a chylothorax and placed on a low fat diet before definitive management with video-assisted thoracoscopic pleurodesis due to persistent drain output. Pleural biopsy taken at the time of surgery showed lymphocytic inflammation consist with pleuritis. On retrospective review of this patients imaging, he had enlarged lymph nodes in the subclavian window adjacent to the thoracic duct, which we suggest likely resulted in obstruction and subsequent leakage of chyle into the pleural space. This case describes a rare cause of chylothorax but also highlights an important differential to be considered in patients presenting with pleural effusion in the setting of tuberculosis infection. This abstract is funded by: None