Spontaneous chylothorax revealing a mediastinal and abdominal lymph node tuberculosis

Introduction: Chylothorax, an uncommon cause of pleural effusion, results from the accumulation of lymph in the pleural space due to damage or obstruction of the thoracic duct. The high content of triglycerides and the presence of chylomicrons set the diagnosis of chylothorax. Spontaneous chylothorax is a rare condition; lymph node tuberculosis is an exceptional etiology of chylothorax. Method: We report an exceptional case of 62 year old woman referred to our hospital complaining of right sided chest pain, fever, non-productive cough and weight loss of 6 kg over the preceding three weeks. Results: Chest examination revealed absent breath sound on right side. Chest X-ray revealed an opaque right hemithorax suggestive of pleural effusion fluid. Erythrocyte sedimentation rate was 38 mm/hour. The pleural aspirate was milky in appearance, with 122 mmol/l triglyceride and 45 mmol/l cholesterol. A computed tomographic scan of the thorax showed a fluid collection with necrotic mediastinal and abdominal lymph nodes. The patient had a mediastinoscopy with biopsy of lymph nodes concluded to tuberculosis. The patient clinically improved and his pleural effusion also completely resolved with anti-tuberculosis treatment. Conclusion: A possible explanation for the development of a chylothorax in our patient is obstruction of the thoracic duct by tuberculous lymphadenopathy with subsequent increase in pressure in the surrounding lymphatic system and leaking of chyle into the pleural space.