Refractory chylothorax in a patient with Waldenström Macroglobulinemia: A case report.

A refractory chylothorax secondary to Waldenström Macroglobulinemia (WM) has rarely been reported in literature, but often responds to chemotherapy and conservative measures. Few reports have been published reporting the use of surgical intervention when standard medical therapies fail. We present a 76-year-old male who developed a large right sided chylothorax with a soft tissue mass encasing the descending thoracic aorta. Pleural fluid flow cytometry and biopsy of the mass demonstrated findings diagnostic of WM. Despite chemoimmunotherapy and conservative measures, he required frequent, high-volume, therapeutic thoracentesis for relief of dyspnea. Thoracic duct embolization (TDE) was performed which resolved the patient's chylothorax, however he subsequently developed lower volume serosanguinous pleural effusions. Patient continued requiring therapeutic thoracentesis bimonthly and ultimately proceeded with pleurectomy of the right lung to achieve resolution of symptoms. To our knowledge, this is the first reported case where pleurectomy has successfully treated refractory pleural effusions in a patient with WM.

Nitrofurantoin-Induced Pulmonary Toxicity: Always Review the Medication List.

Use of nitrofurantoin for uncomplicated cystitis and recurrent urinary tract infections is common practice. While the majority of patients tolerate this medication without issue, it is important to be cognizant of adverse reactions, as these can impact patient's quality of life. Nitrofurantoin-induced pulmonary toxicity is a rare side effect that can present with various clinical manifestations, imaging abnormalities, and pathologic findings. We describe a case of chronic pneumonitis in a patient on suppressive nitrofurantoin therapy presenting with dyspnea and hypoxemia.