A 21-year-old male presented with a 3-week history of chest and lumbar pain, fever, and unquantified weight loss.
During the last week he had presented dry cough and progressive exertional dyspnea that reached ortopnea.
The physical examination revealed cervical polyadenopathies that formed a conglomerate of 10 x 14 cm to the left and hepatolithiasis.
Chest radiography showed mediastinal widening of 12 cm and extensive right pleural occupation.
A pleural drainage tube was installed and 2,000 cc of pleural fluid was delivered.
Cytochemical analysis revealed: triglycerides 247 mg/dl, cholesterol 23 mg/dl, with lymphocyte count of 800 x mm3, with 80% mononuclear.
Negative culture.
Cervical lymph node biopsy showed non-Hodgkin lymphoma of large anaplastic cells.
The most important laboratory tests were Hb.
12.4 gr/dl, GB 13.800 x mm3; with only 5% lymphocytes, proteins 5.5 gr/dl, albumin 2.9 gr/dl. Computed axial tomography of the thorax revealed multiple lymph nodes with conformal lobes that
On the fourth day of admission he received the first cycle of chemotherapy with cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP), despite which appeared left pleural occupation that was drained, obtaining also chylous fluid.
In the following days, total drainage on both sides was maintained at about 2,000 cc.
Three days after the first chemotherapy cycle and given the persistence of chylous drainage, a fasting regimen and total parenteral nutrition were indicated.
It was decided not to perform surgical treatment (pleurodesis) due to the patient's poor general condition and high drainage output.
Seven days after the first chemotherapy cycle, the patient received subcutaneous administration of 50 μg c/12 h octreate, two times a day drainage color change to a clear aspect, without changes in subcutaneous volume.
Cytochemical analysis 24 h after the onset of right octreotide showed triglycerides in left drainage and triglycerides 34 mg/dl and 27 mg/dl, cholesterol 23 mg/dl and 24 mg/dl, respectively.
The patient remained with a debit of about 2,000 ml (total both drainages) but with stabilization and progressive increase of albumin and plasma proteins, dropping the debit significantly on the sixth day post-discharge that re-treatment CHOP.
She was discharged in good condition 3 days later, total 38 days of hospitalization.
