CHEST Guidelines-A-35-Year-Old-Man-With-Recurrent-Pneumonia-and-Whi

A-35-Year-Old-Man-With-Recurrent-Pneumonia-and-Whi

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This case study describes a 35-year-old man with recurrent pneumonia, exertional dyspnea, and a productive cough with whitish, viscous sputum. The symptoms persisted over two months, with a notable weight loss of 5 kg. The patient had a 10 pack-year smoking history but no significant medical history or use of medication. Physical examination showed inspiratory crackles in the right lung, but no other abnormalities.<br /><br />Diagnostic tests revealed decreased lung function and a CT scan showing septal thickening and patchy ground-glass attenuation in the right lung. Laboratory tests were mostly normal, with negative results for common infectious and autoimmune markers. Bronchoalveolar lavage showed milky fluid rich in lipid-laden macrophages. Further imaging through noncontrast MRI and lymphography highlighted an excessive proliferation of thoracic lymphatic vessels, consistent with diffuse pulmonary lymphangiomatosis (DPL).<br /><br />The primary diagnosis was chyloptysis due to DPL. This condition is characterized by abnormal lymphatic development, causing symptoms like milky-white sputum due to lymphatic leakage into the bronchial tree. DPL features complex lymphatic channels that expand within the lungs and can lead to complications like chylothorax.<br /><br />Treatment mainly involves supportive care, including dietary modifications like a fat-free diet, which significantly improved the patient’s symptoms and lung function. No specific therapies exist for DPL, but surgical and systemic interventions may alleviate symptoms in some cases. Following dietary changes, the patient's symptoms improved within four weeks, with no recurrence in seven months.<br /><br />This case highlights that chyloptysis in adults should prompt investigations for lymphatic obstruction causes. Diagnostic imaging such as MRI lymphography is crucial for identifying lymphatic abnormalities and guiding management strategies.

Keywords

recurrent pneumonia

exertional dyspnea

chyloptysis

diffuse pulmonary lymphangiomatosis

lymphatic obstruction

MRI lymphography

lipid-laden macrophages

dietary modifications

lymphatic vessels

ground-glass attenuation