Catching a zebra in a surgical ward: atypical case of chylothorax caused by filariasis in a lupus patient—a case report from a surgical perspective

Filariasis is a tropical disease caused by filariae, parasitic worms belonging to the phylum Nematoda. The clinical manifestations include asymptomatic microfilaremia, fever, lymphatic obstruction, and tropical eosinophilia. Chylothorax is the accumulation of chylous substances within the pleural space and is caused by thoracic duct damage or obstruction. Filariasis and systemic lupus erythematosus (SLE) have been identified as rare but potential causes of chylothorax. We reported a case of a 21-year-old North Sumatran female patient with SLE who presented in the surgery ward with a chief complaint of shortness of breath. On physical examination, dullness on palpation and diminished breath sound with rhonchi on auscultation were found over the lower two-thirds of the lung area. X-ray examination revealed pleural effusion in both lungs. The diagnosis of filariasis was confirmed via PCR and microscopic examination. Chylous pleural fluid was evacuated from both hemithoraxes following thoracotomy. The patient was also treated pharmacologically with bronchodilators, mucolytics, corticosteroids, and anthelminthics. This rare case of bilateral chylothorax caused by Brugia malayi in a patient with SLE highlights the need to consider filariasis in unexplained pleural effusions, especially in endemic regions. Early diagnosis and conservative antiparasitic therapy can yield excellent outcomes without surgical intervention.