Aggressive Recurrent Bilateral Chylothorax Secondary to Follicular Lymphoma in an HIV-Positive Patient: A Case Report and Clinical Implications.

Chylothorax is an infrequent form of pleural effusion, primarily associated with trauma or cancer. Bilateral chylothorax resulting from follicular lymphoma is especially rare, even more so in immunocompromised patients like those with HIV. Such cases can present diagnostic challenges by resembling infectious conditions. A 52-year-old male with stable HIV presented with worsening shortness of breath and was found to have bilateral pleural effusions. While initial assessments prioritized infectious causes, pleural fluid analysis demonstrated significantly elevated triglycerides, establishing the diagnosis of chylothorax. Imaging revealed widespread lymph node enlargement, and a biopsy confirmed advanced follicular lymphoma. After diagnosis and placement of a portacath, the patient was lost to follow-up and later returned with recurrent bilateral chylothorax. This case demonstrates a rare and aggressive manifestation of follicular lymphoma, ordinarily a slow-growing cancer, in an immunocompromised patient. Pleural effusions in individuals with HIV are often presumed infectious, which can delay the detection of underlying malignancies. Healthcare providers should include lymphoproliferative disorders in the workup of persistent pleural effusions, regardless of infectious risk factors, to ensure prompt oncologic referral. This case contributes to the scarce literature on chylothorax from follicular lymphoma and underscores the importance of a broad diagnostic perspective in immunocompromised patients.