P3.13-02 Lymphocytic Plevral Effusion Due to Crizotinib Usage: First Case in Literature

Abstract

Crizotinib is an ALK inhibitor and used for treatment in advanced stages lung adenocarcinoma patients with ALK (+). Most common side effects are; gastrointestinal disorder and visual side effects. Drugs are one of the reasons of effusion. For accurate diagnosis patients’ drug history should be questioned in details. To the best of our knowledge pleural effusion due to crisotinib treatment does not exist in current literature. 41 years old female patient’s admitted to outpatient clinic with chest pain. There was a right hilar lesion and pleural effusion on right hemithorax (Figure 1A). Thorax tomography revealed 5 cm mass lesion in right middle lobe. Transthoracic needle aspiration biopsy reported as adenocarcinoma. Tissue was positive for ALK-rearrangement and first line crizotinib initiated. In the third month of treatment bilateral pleural effusion more in the right was occurred (Figure 1B and 1C). Primary lesion was regressed (Figure 1D). Efusion on left hemithorax was serous and exudate. Any malignant cells were observed. It was drained with pleural catheter and performed talk pleuredesis. There were lymphocytic cell predominance. Others reasons were excluded. Crizotinib treatment was interrupted, in 15th day of crizotinib free observation fluid’s amount decreased. To increase the rate of recovery methylprednisolone 40 mg/day is added. Crizotinib started again with frequent clinical, radiological follow-up. Fluid’s amount did not increase when steroid dose was tapered. While patient take 16 mg/day crizotinib, it has been seen that left pleural fluid disappeared and right pleural thickening appeared due to talc pleuredesis (Figure 1E and 1F). To the best our knowledge there is not case report with pleural effusion related to ALK TKI treatment. Our case is the first to demonstrate the relationship between ALK TKI treatment and pleural effusion. The case which response to the treatment newly formed pleural effusion’s source may have thought as medication.