chylothorax and chylous ascites , which is characterized by the presence of chyle in the pleural and peritoneal cavities , is an uncommon condition [ 1 , 2 ] . tuberculosis ( tb ) can cause cylothorax or chylous ascites [ 3 , 4 , 5 ] , but the concurrent occurrence of both manifestations associated with tuberculosis is extremely rare . a 17-year - old girl was admitted to the korean university ansan hospital with a one - month history of fever , abdominal distention and dyspnea . the patient had been treated in another hospital for 10 days but the cause of ascites and pleural effusion had not been discovered . body temperature was 38.6 , heart rate was 146/min and body weight was 56 kg . on chest auscultation , breathing sound was decreased on both lower lung fields . a chest radiograph taken on admission showed diffuse fine nodular opacities in both lungs and bilateral pleural effusion . chest computed tomography ( ct ) showed pleural effusion of both sides , more serious on the left side , and pericardial effusion and multifocal nodular consolidation on both lung fields ( fig . abdominal ct showed a large amount of ascites with diffuse peritoneal thickening and multiple necrotic lymphadenopathy in the abdominal cavity , and enhanced wall thickening in the distal ileum and ascending colon ( fig . initial laboratory results were as follows : white blood cell count 6,670/mm , hemoglobin 6.7 g / dl , serum total protein 4.6 g / dl and albumin 2.2 g / dl . thoracentesis and paracentesis were performed to verify the nature of fluid apparent in the chest and abdominal ct images . 2a ) was turbid and whitish - colored , with ph 8.0 , protein level 3.1 g / dl , lactate dehydrogenase of 5,855 iu / l , triglyceride 133 mg / dl and adenosine deaminase 121.6 iu / l . the lactate dehydrogenase ratio of pleural fluid versus serum was 15 , consistent with exudate . 2b ) was milk - like and turbid in appearance , ph 8.0 , albumin level 0.5 g / dl , triglyceride we diagnosed chylothorax and chylous ascites because the triglyceride level of pleural fluid and ascites were higher than 110 mg / dl and 200 mg / dl , respectively . direct smear of pleural fluid and ascites for acid fast bacilli ( afb ) was positive only in pleural fluid . so , finally we diagnosed the patient as having tb associated with chylothrax and chylous ascites on the basis of positive afb stain and abdomen ct . initially , the patient received anti - tb treatment with quadritherapy including isoniazid 300 mg / day , rifampin 600 mg / day , pirazinamide 1,500 mg / day and etambutol 1,200 mg / day . the patient also was put on a high protein and low fat diet with medium chain triglyceride . mycobacterium tuberculosis was cultured from sputum and pleural fluid on 28th day from admission and the isolate was susceptible to all anti - tb medications . the patient improved continuously after anti - tuberculosis medication , and pleural effusion and ascites were slightly decreased on follow - up chest and abdomen x - ray . the patient was discharged on day 60 of hospitalization with ongoing anti - tuberculosis treatment . chlyothorax and chylous ascites is characterized by chyle in the pleural and peritoneal cavities produced by obstruction and disruption of the lymphatic channel . the reported incidence of the combined occurrence of chylothorax and chylous ascites has varied from 9% to 55% of chylous effusion [ 5 , 6 ] . the most common cause of nontraumatic chylous effusion is a malignancy , such as lymphoma or metastatic carcinoma [ 3 , 4 ] . other causes of nontraumatic chylous effusion include idiopathic , congenital anomaly , protein - losing enteropathy and tb [ 7 , 8 ] . one case of systemic lupus erythematosus   and one case of henoch - schnlein purpura   accompanied by chylothorax and chylous ascites at a same time have been reported . our case did not have any other cause of chylothorax or chylous ascites except tb . the patient denied any history of trauma , chest and abdominal ct scan did not show any evidence of malignancy and repeated cytologic examinations of pleural effusion and ascites did not reveal malignant cells . constrictive pericarditis , possible cause of chylothorax and chylous ascites , was not noted on the result of echocardiography . m. tuberculosis was isolated from sputum and pleural fluid , but not from ascites . despite the low adenosine deaminase level in ascites and a negative reaction for tb upon polymerase chain reaction examination , an abdominal ct scan showed multiple necrotic lymphadenopathy in the abdominal cavity , which was suggestive of tb infection . as a result , we diagnosed chylothoax and chylous ascites due to tb infection . the mechanism of tb for development of chylothorax and chylous ascites may be related to the enlarged lymph node obstructing lymphatic duct or direct invasion to lymphtic system inducing inflammation [ 10 , 11 , 12 , 13 ] . the mainstay of the treatment of chylothorax or chylous ascites is conservative measures and correcting the underlying causes . the patient received anti - tb medication and nutrition replacement with high protein and low fat meal with medium chain triglycerides . during the first two weeks after this therapy , the patient still complained of dyspnea and abdominal discomfort , and repetitive paracentesis and thoracentesis after one month , a follow - up chest x - ray revealed decreased pleural effusion and abdominal distension was also improved . although some case reports have described the use of octreotide in the management of chylothorax or chylous ascites [ 14 , 15 , 16 , 17 , 18 , 19 ] , our patient improved with a regimen of anti - tb medication , diet control and supportive care ; octreotide was not used . the concurrent occurrence of both manifestations associated with tuberculosis is extremely rare . with considering high prevalence of tb in korea , however ,
chylothorax or chylous ascites is rare manifestation of tuberculosis . 
 we report a case of simultaneous chylothorax and chylous ascites due to tuberculosis . 
 a 17-year - old girl was admitted with fever , abdominal distention and dyspnea . 
 chest and abdominal computed tomography revealed bilateral pleural effusion , multifocal nodular consolidation on both lung fields and copious ascites and multiple necrotic lymphadenopathy in the abdominal cavity . 
 mycobacterium tuberculosis was isolated from sputum and pleural fluid . 
 the patient was treated with anti - tuberculosis medication . 
 pleural effusion and ascites improved with the medication .