CHEST Guidelines-Intrapleural-Hyaluronidase-in-Viscous-Malignant-Me

Intrapleural-Hyaluronidase-in-Viscous-Malignant-Me

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The document reports a novel intervention for managing viscous malignant pleural effusion (MPE) in a patient with mesothelioma. A 66-year-old man with recurrent symptomatic right-sided MPE experienced high fluid viscosity due to hyaluronic acid, leading to prolonged drainage times. Traditional drainage methods were inadequate, with earlier attempts taking excessive time to remove the fluid.<br /><br />To address the viscosity issue, 1500 units of intrapleural hyaluronidase were administered. Hyaluronidase works by breaking down hyaluronic acid, a substance that contributes to fluid’s high viscosity. The administration of hyaluronidase significantly reduced the pleural fluid’s viscosity from an initial 130.14 mPa.s to 3.61 mPa.s within 60 minutes. This led to a markedly enhanced drainage time, allowing for rapid evacuation of the pleural effusion without adverse effects or abnormal vital signs.<br /><br />This case highlights the safety and feasibility of using intrapleural hyaluronidase as a treatment for hyaluronic acid-rich viscous MPE. The findings suggest that intrapleural hyaluronidase can offer a viable solution where other treatments fall short. While traditional studies have not extensively explored its use since the mid-20th century, this modern application underscores the potential benefits of the enzyme in reducing fluid viscosity, enhancing drainage, and possibly extending its use in similar conditions.<br /><br />Previous treatments, like alteplase and dornase alfa, showed limited efficacy in reducing viscosity. Hyaluronidase offers a significant advantage as its enzymatic action directly targets the hyaluronic acid, a key factor in fluid thickening. The report calls for further studies and exploration of optimal dosing and procedural details to substantiate and expand upon these findings.

Keywords

malignant pleural effusion

mesothelioma

hyaluronic acid

hyaluronidase

viscosity reduction

pleural drainage

intrapleural treatment

enzyme therapy

fluid evacuation

medical intervention