Abstract Background Dasatinib, a second-generation tyrosine kinase inhibitor (TKI) used in chronic myeloid leukemia (CML), can cause pleural effusion in up to 20-30% of patients. The proposed mechanism involves immune-mediated endothelial injury and increased capillary permeability. Because the presentation can resemble pneumonia or heart failure, early recognition is essential to prevent morbidity and optimize oncologic therapy. Case Report A 67-year-old woman with CML (BCR-ABL positive) on dasatinib presented with progressive dyspnea and productive cough. CT chest revealed a large right-sided and small left-sided pleural effusion. She was afebrile, saturating well on 2 L nasal cannula. Thoracentesis removed 1500 mL of exudative, lymphocyte-predominant fluid; cytology and cultures were negative. BNP was normal, and echocardiogram showed preserved ejection fraction (65%) with grade I diastolic dysfunction. Dasatinib-induced pleural effusion was suspected. She was started on prednisone 40 mg with taper, and dasatinib was held. Follow-up imaging showed marked improvement. Discussion Dasatinib-related effusions are typically chronic, exudative, and lymphocytic. Risk factors include advanced age, cardiac comorbidities, and long treatment duration. The diagnosis requires exclusion of infection and malignancy. Management includes TKI interruption or dose reduction, corticosteroids, and occasional diuretics or repeat drainage. Conclusion In CML patients on dasatinib presenting with dyspnea and exudative effusion, drug-induced pleural effusion should be strongly considered. Prompt recognition and multidisciplinary management can prevent recurrence and unnecessary antibiotic exposure. This abstract is funded by: None
Mohamed et al. (Fri,) studied this question.