Treatment of Chylothorax with Pleurodesis, a Lesser Known Complication of Behçet's Disease: A Case Report
Behçet's Disease (BD) is a multisystemic vasculitis which usually affects optical, genital, and oral mucosae and often reoccurs intermittently. Chylothorax is a very rare complication of BD which usually causes thrombosis in the major venous system. A 27-year-old man with a 10-year history of BD referred to our cardiovascular surgery department with symptoms of serious aches in the left arm, edema, and apparent veins on the left anterior chest wall. A total thrombosis of the left internal and external jugular veins and the left subclavian vein was observed. One month after a successful treatment and discharge, the patient returned to our clinic with symptoms of dyspnea and coughs. A chest radiograph showed a consolidated region. A milky liquid was aspirated through thoracocentesis from the left thorax, and its biochemical analysis helped us arrive at a diagnosis of chylothorax. The patient was hospitalized and administered corticosteroids and immunosuppressive therapy with a high-carbohydrate and low-fat dietary regimen for BD. Thereafter, a left thoracic drainage system was established. On the seventh day of hospitalization, due to a progressing cheilosis flow, a pleurodesis process was applied with talcum powder. However, the chylous drainage was continued and 60 mL of venous autologous blood was injected into the left thorax through a drainage tube. The treatment was successful, and the patient was discharged from the hospital uneventfully. At 1 month’s follow-up, the chest radiograph was normal.
Yoo WH, Moon JS, Kim SI, Kim WU, Min JG, et al. A Case of Behcet's Disease with Superior and Inferior Vena Caval Occlusion. The Korean Journal of Internal Medicine Korean J Intern Med. 1998 July;13(2):136-9.
Calamia KT, Schirmer M, Melikoglu M. Major vessel involvement in Behcet’s disease. Curr Opin Rheumatol 2005;17:1-8.
Erkan F, Gül A, Tasali E. Pulmonary manifestations of Behcet’s disease. Thorax 2001;56:572–8.
Zouboulis CC. Epidemiology of Adamantiades Behcet’s disease. Ann Med Interne 1999;150:488–99
Mendes D, Correia M, Barbedo M, Vaio T, Mota M, Gonçalves O, Valente J. Behcet’s disease - a contemporary review. J Autoimmun 2009;May-Jun;32(3-4):178-88.
Sarica-Kucukoglu R, Akdag-Kose A, KayabalI M, Yazganoglu KD, Disci R, et al. Vascular involvement in Behcet’s disease: a retrospective analysis of2319 cases. Int J Dermatol 2006; 45: 919-21.
Yüksel M, Güler S. Duktus torasikus anatomisi ve şilotoraks. Göğüs Cerrahisi Bilmedya Grup 1. baskı. İstanbul 2001:1;521-35.
Ozcelik C, Onat S, Bayar ES. Combined late diagnosed right main bronchial distruptionand chylothorax from blunt chest trauma. Ann Thorac Surg 2004;78:61-2.
Moon H, Lee YJ, Lee SI, Yoo WH. Chylothorax and chylopericardium as the initial clinical manfestation of Behcet’s disease. Rheumatol Int 2008;28:375-7.
Jaaly AE, BaigK, Patni R, Anderson J, Haskard D. Surgical management of chylopericardium and chylothorax in a patient with Behçet’s disease. Clin Exp Rheumatol 2011;29(Suppl. 67):68-70.
Çöplü L, Emri S, Selçuk ZT,Kalyoncu Z, Balkancı F, et al. Life threatening chylous pleural and pericardial effusion in a patient with Behcet's syndrome Thorax 1992;47:64-5.
Maayan H, Izbicki G, Heyd J, Cyter R, Silberman S, Deeb M. Persistent chylothorax in Behçet’s disease treated with a blood patch. Isr Med Assoc J 2008; 10: 588-9.