A 68-Year-Old Man With Chronic Myelogenous Leukemia and a Large Unilateral Pleural Effusion

A 68-year-old man with chronic myelogenous leukemia presents for evaluation of 2 months of dyspnea with exertion. He denies cough, fever, chest pain, weight gain, orthopnea, and edema. Since diagnosis of chronic myelogenous leukemia 5 years ago, he has been treated with dasatinib, with recent BCR-ABL1 assay showing no detectable disease in the peripheral blood. Medical history also includes hyperlipidemia, prostate enlargement, and hypothyroidism, but no prior heart or lung disease. Born in the Middle East, he immigrated to the United States 30 years ago and is working as a physician. He received the Bacillus Calmette-Guérin vaccine as a child. Quantiferon Gold test 1 year ago was positive (TB antigen response 0.91, reference range in <0.35), but he has not received treatment for this. He is a lifelong nonsmoker and rarely drinks alcohol. Medications include dasatinib, rosuvastatin, levothyroxine, tamsulosin, and dutasteride.