Unexpected Complications: A Case of Imatinib-induced Serositis Leading to Pericardial and Recurrent Bilateral Pleural Effusions

Document Type

Abstract

Publication Date

5-1-2025

Abstract

Introduction: Imatinib, a tyrosine-kinase inhibitor used to treat chronic myelogenous leukemia (CML), is generally well-tolerated. However, it can cause serositis in less than 1% of individuals. Here, we present a case of imatinib-induced pericardial effusion with pre-tamponade physiology and bilateral pleural effusions. Case: A 72-year-old male with a history of stage 3 A lung adenocarcinoma, esophageal adenocarcinoma in remission, CML on imatinib since 2017, and a history of recurrent pleural effusions presented to the hospital with shortness of breath and cough. He was recently admitted with similar symptoms and required a right-sided chest tube placement for sizeable exudative pleural effusion with a negative cytology. He was offered VATS with pleural biopsy and pleurodesis, but he declined. This time, he was initially hypotensive (BP 90/66 mm Hg), tachycardic (heart rate 90 bpm), and afebrile. Decreased breath sounds were auscultated bilaterally. CBC showed a WBC count of 10,700 per microliter, hemoglobin 7.7 g/dl, troponin 59 ng/L, BNP 108 pg/ml, and lactic acid 2.1 mmol/l. A chest x-ray showed unchanged small pleural effusions. A CT chest showed small bilateral pleural effusions (more significant on the left) and a large pericardial effusion. An urgent echocardiogram showed massive circumferential pericardial effusion with the deepest pocket adjacent to the right ventricle measuring 2.1 cm and pre-tamponade physiology. Given the recurrence of pleural effusions and large pericardial effusion, there was concern for malignancy vs imatinib-induced serositis. Pericardiocentesis yielded approximately 290 mL of serosanguinous fluid, and fluid analysis revealed exudative characteristics, with cytology negative for malignancy. He also underwent left-sided VATS, pleural biopsy, and pleurodesis, with fluid analysis consistently showing exudative fluid with no malignancy. Oncology was consulted, and it was suspected that the patient's recurrent pleural effusions and unremarkable pleural and pericardial fluid studies with negative biopsies were likely due to imatinib-induced serositis. Given this suspicion, imatinib was discontinued. His CML had been in remission since 2022. A onemonth follow-up showed no recurrence of effusion. Discussion: Imatinib-induced serositis is rare and presents as pleural/pericardial effusions. It has been reported in patients initiating therapy and in some studies up to 2 years after initiating imatinib. Our case is interesting because our patient has been on a stable imatinib regimen since 2017. Clinicians should consider this rare adverse effect in patients on long-term imatinib therapy.

Publication Title

American Journal of Respiratory and Critical Care Medicine

Volume

211

Issue

Abstracts

First Page

A6238

Last Page

A6238

Comments

American Thoracic Society International Conference, ATS 2025 held 2025-05-16 to 2025-05-21 in San Francisco, CA

Link to Full Text

Open Access

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