Bilateral Malignant Pleural Effusion as an Initial Manifestation of Acute Lymphoblastic Leukemia: A Rare Case Report

Author(s): Gajjar Jay Daxay, Vyakhya, Ajeta Vijaykumar Gupta, Bhagwan Sahai Sharma, Susheel Kumar Saini*, Madhur sarthalia, Ajay Kumar Saini

Exudative pleural effusion in children is mainly caused by bacterial infections. Leukemia rarely presents as pleural effusion as the first manifestation of the disease process. Bilateral malignant pleural effusion as an initial manifestation that leads to the diagnosis of an underlying acute lymphoblastic leukemia is a rare event. Most commonly pleural effusion is seen as complication in solid tumors such as the lung, lymphomas, carcinomas of the breast and gastrointestinal tract.

We report a case of 15 yrs. old girl presented with bilateral massive pleural effusion and respiratory failure. She was initially diagnosed as a case of pulmonary tuberculosis but evaluated further due to poor response to antitubercular treatment. She was finally diagnosed as a case of B cell Acute Lymphoblastic Leukemia. She underwent induction chemotherapy which led to significant clinical improvement due to resolution of the pleural effusion. The patient is on chemotherapy at present. This case report highlights the importance of cytopathological analysis of body cavity fluids in the diagnosis of underlying unsuspected malignancies.

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