Case Report: Dasatinib-associated chylothorax and occult Bartonella henselae infection in pediatric leukemia: a case report and systematic review.

Authors

Caili Liu, Ziting Xia, Runxin Lu, Hongye Cai, Chunxi Fu, Shuai Peng, Liang Huang, Xiaoxi Lu

Published in

Frontiers in pharmacology. Volume 17. Pages 1897328. Epub Sep 28, 2026.

Abstract

Dasatinib is a second-generation tyrosine kinase inhibitor (TKI) used in Philadelphia chromosome-positive (Ph+) acute lymphoblastic leukemia (ALL), and chylothorax is one of its rare but serious lymphatic complications. We encountered a 14-year-old boy with Ph + acute lymphoblastic leukemia (ALL) who developed bilateral chylothorax while on dasatinib, with concurrent B. henselae infection (cat-scratch disease) confirmed in the pleural fluid. Prompted by this index case, we performed a systematic review of the literature to explore the potential association between dasatinib-associated chylothorax and Bartonella henselae infection. We searched multiple databases up to March 2026 and identified 24 cases of TKI-associated chylothorax and 11 cases of leukemia-related cat-scratch disease. In our index case, the pleural fluid triglyceride concentration reached 20.40 mmol/L (≈1806 mg/dL)-the highest value reported to date-and mNGS detected B. henselae together with other organisms. After dasatinib was discontinued and the patient received chest drainage, somatostatin, fasting, and anti-infective therapy with doxycycline plus rifampicin, imaging showed near-complete resolution of the effusion, and repeat mNGS confirmed clearance of B. henselae. A formal causality assessment using the Naranjo scale gave a score of 7, indicating a "probable" adverse drug reaction. This case illustrates that lymphatic and infectious complications can coincide in the same patient. Dasatinib-mediated inhibition of Src family kinases may simultaneously impair lymphatic endothelial integrity and suppress T-cell-mediated immune surveillance, thereby facilitating both chylous leakage and opportunistic infection. Clinicians managing paediatric patients receiving long-term dasatinib therapy should remain vigilant for both lymphatic complications and atypical opportunistic infections.

PMID:
42865411
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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