title: Simultaneous manifestation of pleural effusion and acute renal failure associated with dasatinib: a case report.
abstract: OBJECTIVE
  Dasatinib is a novel second-generation inhibitor of multiple tyrosine kinases, indicated for the treatment for Philadelphia chromosome-positive (Ph+) chronic myeloid leukaemia (CML), acute lymphoblastic leukaemia (ALL) and lymphoid blast CML with resistance or intolerance to prior therapy. Although dasatinib is a potent, efficacious and generally well-tolerated drug, patients are also subject to various adverse effects. The most common pulmonary-related side effect is pleural effusion (PE). Renal failure has been reported rarely as a side effect of dasatinib treatment. We report the first case of a patient with imatinib-resistant CML who developed PE and acute renal failure (ARF) simultaneously, after being placed on dasatinib therapy.
  
  
  METHODS
  We report a 58-year-old female dasatinib-treated patient with Ph+ chronic phase CML who was admitted to our hospital due to persisted dyspnoea and fever. After reviewing the laboratory and clinical findings, we determined our patient as having simultaneously ARF and PE related to dasatinib therapy. Dasatinib was discontinued, and after 10 days of treatment with ampicillin-sulbactam, allopurinol, amlodipine, furosemide and methylprednisolone, she was discharged home effusion free and with ameliorated renal function.
  
  
  CONCLUSIONS
  PE is the most common extra-haematological toxicity observed during dasatinib treatment whose pathogenesis is still unclear. A possible role of cytokines, such as platelet-derived growth factor receptor (PDGFR)-β and vascular endothelial growth factor (VEGF), in causing endothelial permeability has been suggested. The aetiology of renal failure is also unclear in these patients, but two different possible mechanisms have been suggested such as tumour lysis syndrome and toxic tubular damage. In conclusion, here we describe the first case of simultaneous manifestation of PE and ARF associated with dasatinib. Thus, in patients treated with tyrosine kinase inhibitors, especially those with predisposing nephrological or haematological factors, serum creatinine levels should be monitored routinely.
authors.affiliation: First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kaiafa
authors.forename: N
authors.initials: N
authors.lastname: Kakaletsis
authors.forename: C
authors.initials: C
authors.lastname: Savopoulos
authors.forename: V
authors.initials: V
authors.lastname: Perifanis
authors.forename: A
authors.initials: A
authors.lastname: Giannouli
authors.forename: N
authors.initials: N
authors.lastname: Papadopoulos
authors.forename: S
authors.initials: S
authors.lastname: Zisekas
authors.forename: A I
authors.initials: AI
authors.lastname: Hatzitolios
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000069439:Dasatinib; D005260:Female; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy; D008875:Middle Aged; D010996:Pleural Effusion / Q000139:chemically induced*; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D013844:Thiazoles / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D011743:Pyrimidines; D013844:Thiazoles; D000069439:Dasatinib
keywords: acute renal failure; adverse event; dasatinib; pleural effusion; simultaneous; tyrosine kinase inhibitor