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Cherian S, Umerah OM, Tufail M, Panchal RK. Chylothorax in a patient with HIV-related Kaposi's sarcoma. BMJ Case Rep 2019; 12:12/1/e227641. [PMID: 30674495 DOI: 10.1136/bcr-2018-227641] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We present a case of a 33-year-old man with a background of HIV and Kaposi's sarcoma (KS), who presented with a right sided chylothorax. He was managed with percutaneous chest drainage and talc pleurodesis, in addition to his chemotherapy and antiretroviral therapy for KS and HIV, respectively. Good clinical control of the chylothorax remained 4 months post drainage. This case report summarises the approach to investigating and managing pleural effusion, and in particular chylothorax, in HIV patients.
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Affiliation(s)
- Sonia Cherian
- Respiratory Medicine, Glenfield Hospital Department of Respiratory Disorders Lung Disorders and Thoracic Medicine, Leicester, UK.,Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester, Leicester, UK
| | - Onyeka Maureen Umerah
- Respiratory Medicine, Glenfield Hospital Department of Respiratory Disorders Lung Disorders and Thoracic Medicine, Leicester, UK.,Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester, Leicester, UK
| | - Muhammad Tufail
- Respiratory Medicine, Glenfield Hospital Department of Respiratory Disorders Lung Disorders and Thoracic Medicine, Leicester, UK.,Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester, Leicester, UK
| | - Rakesh K Panchal
- Respiratory Medicine, Glenfield Hospital Department of Respiratory Disorders Lung Disorders and Thoracic Medicine, Leicester, UK.,Respiratory Medicine, Institute for Lung Health, Glenfield Hospital, Leicester, Leicester, UK
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2
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Pitcher RD, Beningfield SJ, Zar HJ. The chest X-ray features of chronic respiratory disease in HIV-infected children--a review. Paediatr Respir Rev 2015; 16:258-66. [PMID: 25736908 DOI: 10.1016/j.prrv.2015.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/16/2015] [Indexed: 11/24/2022]
Abstract
Several features of human immunodeficiency virus (HIV) infection contribute to the development of chronic respiratory disease in children. These include the frequency and severity of acute chest infections, as well as the increased risk of pulmonary tuberculosis, aspiration, cardiovascular disease, lymphocytic interstitial pneumonitis or pulmonary neoplasia. The chest radiograph (CXR) remains the most accessible investigation for respiratory disease and plays an important role in the baseline assessment and follow-up. This review focuses on the CXR abnormalities of HIV-related chronic respiratory disease in children. The most commonly documented chronic CXR abnormalities are homogeneous opacification and pulmonary nodules, with pulmonary tuberculosis and lymphocytic interstitial pneumonitis the leading respective causes. Deficiencies in radiographic reporting methodology and relative paucity of radiographic data contribute to current limitations in knowledge and understanding of this field. The review highlights the need for standardised terminology and systematic reporting methodology in future studies. Prospective research on the natural history of lymphocytic interstitial pneumonitis, response to anti-tuberculous therapy, the impact of anti-retroviral therapy and HIV-associated bronchiectasis are needed.
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Affiliation(s)
- Richard D Pitcher
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa.
| | - Stephen J Beningfield
- Division of Radiology, Department of Radiation Medicine, New Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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3
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Natarajan P, Miller A. A case of relapsed visceral Kaposi's sarcoma with bilateral chylothoraces successfully treated with paclitaxel. Int J STD AIDS 2014; 26:605-9. [PMID: 25122577 DOI: 10.1177/0956462414546915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 06/30/2014] [Indexed: 11/16/2022]
Abstract
Chylothorax is a rare complication of visceral Kaposi's sarcoma. We report a case with bilateral chylothoraces secondary to relapsed visceral Kaposi's sarcoma who was successfully treated with paclitaxel chemotherapy.
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Affiliation(s)
- Pavithra Natarajan
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Alastair Miller
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital, Liverpool, UK
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4
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El Hammoumi MM, Drissi G, Achir A, Benchekroun A, Kabiri EH, Benosman A. [Spontaneous bilateral chylothorax revealing a mediastinal and abdominal lymph node tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2014; 70:173-176. [PMID: 24210151 DOI: 10.1016/j.pneumo.2013.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 06/24/2013] [Accepted: 06/29/2013] [Indexed: 06/02/2023]
Abstract
Spontaneous chylothorax is a rare condition, lymph node tuberculosis is an exceptional etiology of chylothorax, we report an exceptional case of a patient with mediastinal and abdominal lymph node tuberculosis presenting with spontaneous bilateral chylothorax treated successfully by symptomatic medical treatment and antibacillary.
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Affiliation(s)
- M M El Hammoumi
- Service de chirurgie thoracique, hôpital militaire d'instruction Mohammed V, université Mohammed-V Souissi, Rabat, Maroc; Centre d'étude doctorale (CEDOC) des sciences de la vie et de la santé, faculté de médecine et de pharmacie, Rabat, Maroc.
| | - G Drissi
- Service des urgences portes chirurgicales, hôpital Avicenne/CHU Ibn-Sina, université Mohammed-V Souissi, Rabat, Maroc; Centre d'étude doctorale (CEDOC) des sciences de la vie et de la santé, faculté de médecine et de pharmacie, Rabat, Maroc
| | - A Achir
- Service de chirurgie thoracique, hôpital Avicenne/CHU Ibn-Sina, université Mohammed-V Souissi, Rabat, Maroc
| | - A Benchekroun
- Service des urgences portes chirurgicales, hôpital Avicenne/CHU Ibn-Sina, université Mohammed-V Souissi, Rabat, Maroc; Centre d'étude doctorale (CEDOC) des sciences de la vie et de la santé, faculté de médecine et de pharmacie, Rabat, Maroc
| | - E H Kabiri
- Service de chirurgie thoracique, hôpital militaire d'instruction Mohammed V, université Mohammed-V Souissi, Rabat, Maroc; Centre d'étude doctorale (CEDOC) des sciences de la vie et de la santé, faculté de médecine et de pharmacie, Rabat, Maroc
| | - A Benosman
- Service de chirurgie thoracique, hôpital Avicenne/CHU Ibn-Sina, université Mohammed-V Souissi, Rabat, Maroc
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Abstract
Chylothorax, the accumulation of chyle in the pleural space, is a relatively rare cause of pleural effusion in children. It can cause significant respiratory morbidity, as well as lead to malnutrition and immunodeficiency. Thus, a chylothorax requires timely diagnosis and treatment. This review will first discuss the anatomy and physiology of the lymphatic system and discuss various causes that can lead to development of a chylothorax in infants and children. Then, methods of diagnosis and treatment will be reviewed. Finally, complications of chylothorax will be reviewed.
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Affiliation(s)
- James D Tutor
- Program in Pediatric Pulmonary Medicine, University of Tennessee Health Science Center; Le Bonheur Children's Hospital; and St. Jude Children's Research Hospital, Memphis, Tennessee
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6
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Wright CA, Pienaar JP, Marais BJ. Fine needle aspiration biopsy: diagnostic utility in resource-limited settings. ACTA ACUST UNITED AC 2013; 28:65-70. [DOI: 10.1179/146532808x270707] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kant S, Verma SK, Anand SC, Prasad R, Verma RK. Development of bilateral chylothorax in a younger female secondary to tuberculosis. Lung India 2011; 28:56-9. [PMID: 21654988 PMCID: PMC3099513 DOI: 10.4103/0970-2113.76303] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Chylothorax is a rare clinical entity characterized by a milky white aspirate with increased triglyceride levels. The commonest etiology is malignancy and trauma, and bilateral chylothorax, secondary to tuberculosis, is an extremely rare cause, as observed in the present case.
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Affiliation(s)
- Surya Kant
- Department of Pulmonary Medicine, CSM Medical University (Formerly King George's Medical University), Lucknow, India
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8
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Tension chylothorax complicating acute malignant airway obstruction. Pediatr Emerg Care 2011; 27:406-8. [PMID: 21546802 DOI: 10.1097/pec.0b013e318216b2f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Acute upper airway obstruction represents one of the most challenging emergencies in pediatric practice. In particular, a tension chylothorax complicating a malignant airway obstruction is a rare and life-threatening complication. We report a rapidly progressing tension chylothorax associated with a cervical mass in a 10-month-old male infant. To our knowledge, the extension of a cervical mass to the supraclavear region resulting in a compressive chylothorax represents an exceptional event in pediatrics. Early recognition and prompt treatment resulted to be essential to relieve the compression and to avoid end-stage hemodynamic and respiratory function derangement.
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Lin JN, Lai CH, Chen YH, Chang LL, Lee SSJ, Lin HH. Immune reconstitution inflammatory syndrome presenting as chylothorax in a patient with HIV and Mycobacterium tuberculosis coinfection: a case report. BMC Infect Dis 2010; 10:321. [PMID: 21059235 PMCID: PMC2988055 DOI: 10.1186/1471-2334-10-321] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 11/08/2010] [Indexed: 11/30/2022] Open
Abstract
Background Patients with human immunodeficiency virus (HIV) infection are at risk for Mycobacterium tuberculosis (TB) coinfection. The advent of antiretroviral therapy restores immunity in HIV-infected patients, but predisposes patients to immune reconstitution inflammatory syndrome (IRIS). Case Presentation A 25-year-old HIV-infected male presented with fever, productive cough, and body weight loss for 2 months. His CD4 cell count was 11 cells/μl and HIV-1 viral load was 315,939 copies/ml. Antituberculosis therapy was initiated after the diagnosis of pulmonary TB. One week after antituberculosis therapy, antiretroviral therapy was started. However, multiple mediastinal lymphadenopathies and chylothorax developed. Adequate drainage of the chylothorax, suspension of antiretroviral therapy, and continued antituberculosis therapy resulted in successful treatment and good outcome. Conclusions Chylothorax is a rare manifestation of TB-associated IRIS in HIV-infected patients. Careful monitoring for development of IRIS during treatment of HIV-TB coinfection is essential to minimize the associated morbidity and mortality.
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Affiliation(s)
- Jiun-Nong Lin
- Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
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10
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Immune reconstitution inflammatory syndrome after initiating highly active antiretroviral therapy in HIV-infected children. Pediatr Radiol 2009; 39:569-74. [PMID: 19277634 DOI: 10.1007/s00247-009-1192-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/15/2009] [Accepted: 01/28/2009] [Indexed: 01/28/2023]
Abstract
The outcome of HIV infection has improved since the widespread availability of highly active antiretroviral therapy (HAART). Some patients, however, develop a clinical and radiological deterioration following initiation of HAART due to either the unmasking of occult subclinical infection or an enhanced inflammatory response to a treated infection. This phenomenon is believed to result from the restored ability to mount an immune response and is termed immune reconstitution inflammatory syndrome (IRIS) or immune reconstitution disease. IRIS is widely reported in the literature in adult patients, most commonly associated with mycobacterial infections. There is, however, a paucity of data documenting the radiological findings of IRIS in children. Radiologists need to be aware of this entity. As a diagnosis of exclusion it is essential that the radiological findings be assessed in the context of the clinical presentation. This article reviews the common clinical and radiological manifestations of IRIS in HIV-infected children.
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Schwartz RA, Micali G, Nasca MR, Scuderi L. Kaposi sarcoma: a continuing conundrum. J Am Acad Dermatol 2008; 59:179-206; quiz 207-8. [PMID: 18638627 DOI: 10.1016/j.jaad.2008.05.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Revised: 04/20/2008] [Accepted: 05/05/2008] [Indexed: 12/11/2022]
Abstract
UNLABELLED Kaposi sarcoma (KS) remains a challenge. Its classic or Mediterranean form tends to be benign. In transplant recipients it may be less so. As part of the AIDS pandemic, of which it was an original defining component, it may be life-threatening. It is due to human herpesvirus-8, which is necessary but not sufficient to produce the disease. KS has a low prevalence in the general population of the United States and United Kingdom, with an intermediate rate in Italy and Greece, and a high one in parts of Africa. In Italy, hot spots include its southern regions, the Po River Valley, and Sardinia, possibly related to a high density of blood-sucking insects. An important challenge is to treat KS patients without immunocompromising them. The potential of effective anti-herpes virus therapy and the use of sirolimus in transplantation recipients have added new opportunities for KS prevention. LEARNING OBJECTIVES At the conclusion of this learning activity, participants should be able to provide the most recent information about Kaposi sarcoma in the context in which it occurs. Its classic or Mediterranean form, its pattern in transplant recipients and others iatrogenically immunosuppressed, and its occurrence as a potentially life-threatening part of the AIDS pandemic will be stressed. Its etiology and transmission will be discussed in detail to facilitate understanding of Kaposi sarcoma and of human herpesvirus-8 infection in the general population of the United States and United Kingdom, in Italy and Greece, and in certain parts of Africa. Its therapy, including the concept of doing it without immunocompromising the patient, will be stressed. New opportunities for Kaposi sarcoma prevention will also be discussed.
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Affiliation(s)
- Robert A Schwartz
- Department of Dermatology, New Jersey Medical School, Newark, New Jersey 07103-2714, USA.
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Pantanowitz L, Dezube BJ. Kaposi sarcoma in unusual locations. BMC Cancer 2008; 8:190. [PMID: 18605999 PMCID: PMC2464778 DOI: 10.1186/1471-2407-8-190] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 07/07/2008] [Indexed: 11/10/2022] Open
Abstract
Kaposi sarcoma (KS) is a multifocal, vascular lesion of low-grade malignant potential that presents most frequently in mucocutaneous sites. KS also commonly involves lymph nodes and visceral organs. This article deals with the manifestation of KS in unusual anatomic regions. Unusual locations of KS involvement include the musculoskeletal system, central and peripheral nervous system, larynx, eye, major salivary glands, endocrine organs, heart, thoracic duct, urinary system and breast. The development of KS within wounds and blood clots is also presented. KS in these atypical sites may prove difficult to diagnose, resulting in patient mismanagement. Theories to explain the rarity and development of KS in these unusual sites are discussed.
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Affiliation(s)
- Liron Pantanowitz
- Department of Pathology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA.
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Theron S, Andronikou S, Du Plessis J, Goussard P, George R, Mapukata A, Grobbelaar M, Hayes M, Wieselthaler N, Davidson A. Pulmonary Kaposi sarcoma in six children. Pediatr Radiol 2007; 37:1224-9. [PMID: 17940761 DOI: 10.1007/s00247-007-0632-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Revised: 07/12/2007] [Accepted: 08/19/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Pulmonary involvement in Kaposi sarcoma is rare in children and can be difficult to distinguish from other pathology. OBJECTIVE To describe the radiological findings in paediatric pulmonary Kaposi sarcoma. MATERIALS AND METHODS Sequential chest radiographs of six children and CT scans of four of these children were evaluated retrospectively. Their ages ranged from 18 months to 10 years; four were male and two were female. All six children were HIV-positive. The observers were two radiologists. RESULTS Chest radiographs revealed air-space (100%) and reticular (83%) opacification in the mid- and lower lung zones; pleural effusions were present in 83% of the children. All the children showed progressive air-space opacification on follow-up radiography. CT demonstrated bilateral air-space opacification in a perihilar distribution in all the children; reticular opacification was seen in 75%. All the children had mediastinal and axillary lymphadenopathy; 75% had bilateral hilar lymphadenopathy. CONCLUSION In both adults and children, chest radiography demonstrates perihilar and lower zone involvement. Pleural effusions are more common on radiographs in children. Air-space disease and lymphadenopathy are much more common on CT in children than adults.
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Affiliation(s)
- Salomine Theron
- Department of Radiology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa.
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