Pachika Pranali S, Dande Ranadheer R, Ngo Phuong
Hematology and Oncology, University of Louisville, Louisville, USA.
Internal Medicine, Baptist Health Hardin Hospital, Elizabethtown, USA.
Cureus. 2025 Apr 28;17(4):e83153. doi: 10.7759/cureus.83153. eCollection 2025 Apr.
Imatinib, a tyrosine kinase inhibitor, is widely used for treating gastrointestinal stromal tumors (GISTs) and chronic myeloid leukemia (CML). While commonly associated with mild fluid retention, significant pleural effusion is an uncommon but potentially serious adverse effect. We present a case of recurrent pleural effusions secondary to imatinib therapy in a 62-year-old female patient with metastatic lung adenocarcinoma and a concurrent GIST harboring an exon 9 mutation. She was initiated on imatinib 400 mg daily, later increased to twice daily. Within weeks, she developed progressive dyspnea, and imaging revealed large bilateral pleural effusions. Pleural fluid analysis demonstrated an exudative effusion, with cytology and microbiological studies ruling out infection or malignancy. Cardiac function was preserved, and there were no signs of volume overload. She underwent multiple thoracenteses for symptomatic relief. Due to recurrent pleural effusions, imatinib was permanently discontinued, leading to complete resolution of the effusions. Subsequent treatment with sunitinib was not tolerated due to severe mucositis and cytopenias. Despite discontinuation of targeted therapy, both her GIST and metastatic lung cancer remained stable under surveillance. While pleural effusions are frequently reported with dasatinib, they are rare with imatinib. The proposed mechanisms include inhibition of platelet-derived growth factor receptors (PDGFRs), leading to increased vascular permeability, impaired lymphatic drainage, and renal sodium retention. Dose reduction may mitigate fluid retention; however, our patient developed significant pleural effusions at standard dosing, necessitating treatment discontinuation. This case underscores the importance of recognizing pleural effusion as a rare but serious adverse effect of imatinib therapy. Clinicians should maintain a high index of suspicion for drug-induced pleural effusions, particularly in the absence of other etiologies, and consider discontinuation if clinically indicated. Early recognition and management can prevent complications and improve patient outcomes.
伊马替尼是一种酪氨酸激酶抑制剂，广泛用于治疗胃肠道间质瘤（GIST）和慢性粒细胞白血病（CML）。虽然通常与轻度液体潴留有关，但大量胸腔积液是一种罕见但可能严重的不良反应。我们报告一例62岁女性患者，患有转移性肺腺癌和同时存在外显子9突变的GIST，因伊马替尼治疗继发反复胸腔积液。她开始每天服用400毫克伊马替尼，后来增加到每天两次。几周内，她出现进行性呼吸困难，影像学检查显示双侧大量胸腔积液。胸腔积液分析显示为渗出性积液，细胞学和微生物学研究排除了感染或恶性肿瘤。心脏功能保持正常，没有容量超负荷的迹象。她接受了多次胸腔穿刺以缓解症状。由于反复出现胸腔积液，伊马替尼被永久停用，积液完全消退。随后使用舒尼替尼治疗因严重粘膜炎和血细胞减少而无法耐受。尽管停用了靶向治疗，但在监测下她的GIST和转移性肺癌均保持稳定。虽然达沙替尼经常报告有胸腔积液，但伊马替尼引起的则很少见。推测的机制包括抑制血小板衍生生长因子受体（PDGFR），导致血管通透性增加、淋巴引流受损和肾钠潴留。减少剂量可能减轻液体潴留；然而，我们的患者在标准剂量下出现了大量胸腔积液，需要停药。该病例强调了认识到胸腔积液是伊马替尼治疗罕见但严重的不良反应的重要性。临床医生应高度怀疑药物性胸腔积液，特别是在没有其他病因的情况下，并在临床指征明确时考虑停药。早期识别和管理可以预防并发症并改善患者预后。
