Exudative pleural effusion during sunitinib treatment

• Published in: BMJ case reports Vol. 17; no. 6; p. e257191
• Main Authors: Gupta, Deepansh, Sivaramakrishnan, Prakash, Layek, Avishek, Mishra, Mayank
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17.06.2024
• Subjects: Adult; Antibodies; Antineoplastic Agents - adverse effects; Blood platelets; Case reports; Chemotherapy; Dehydrogenases; Drug dosages; Ejection fraction; Gastrointestinal cancer; Gastrointestinal Stromal Tumors - drug therapy; Growth factors; Heart failure; Hemoglobin; Humans; Hypertension; Hypothyroidism; Indoles - adverse effects; Indoles - therapeutic use; Inhibitor drugs; Kinases; Leukocytes; Lymphatic system; Male; Peptides; Pleural effusion; Pleural Effusion - chemically induced; Pleural Effusion - diagnostic imaging; Potassium; Proteins; Pulmonary arteries; Serology; Sunitinib - adverse effects; Sunitinib - therapeutic use; Targeted cancer therapy; Thoracentesis; Thyroid gland; Tomography, X-Ray Computed; Malignant disease and immunosuppression; Respiratory medicine; Chemotherapy
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2023-257191

Drug-induced pleural effusion is one of the rare causes of exudative pleural effusion and a high index of suspicion is necessary to lead to early diagnosis. We hereby present the case of a young male in his late 30s, known case of metastatic gastrointestinal stromal tumour on sunitinib therapy, who presented with right-sided mild pleural effusion. Diagnostic thoracentesis showed the effusion to be a monomorphic exudate with low adenosine deaminase, which was negative for malignant cells on cytopathology. A contrast-enhanced CT chest revealed an enlarged lymph node (LN) at the 4R station, cytological analysis of which was suggestive of reactive lymphoid hyperplasia. Infective workup of the LN aspirate and bronchoalveolar lavage taken from the right middle lobe was negative. After systematically excluding the usual causes of exudative pleural effusion, sunitinib was considered to be a possible cause and was, therefore, withheld. A repeat chest X-ray after 3 weeks of stopping the drug showed resolution of the pleural effusion.