Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management

Authors

  • Vikas Marwah MD (Pulmonary Medicine), Senior Consultant, Dept of Pulmonary, Critical care and sleep medicine, AICTS, Pune, India.
  • Gaurav Bhati MD (Pulmonary Medicine), Senior resident, Dept of Pulmonary, Critical Care and Sleep Medicine, AICTS, Pune, India.
  • Robin Chaudhary MD (Pulmonary Medicine), Consultant, Dept of Pulmonary, Critical care and sleep medicine, Base Hospital Delhi Cantt, New Delhi, India. https://orcid.org/0000-0002-9641-6849
  • Anmol Sharma MBBS, Resident Internal Medicine, Base Hospital Delhi Cantt, India. https://orcid.org/0000-0003-1184-5298

DOI:

https://doi.org/10.5195/ijms.2023.1996

Keywords:

Tuberculosis burden in low- and middle-income countries, Multidrug-resistant tuberculosis (MDR-TB), Impact of TB on coagulation parameters, Venous thromboembolism (VTE) in acute and chronic infections, Complications of VTE in tuberculosis patients, Pulmonary thromboembolism (PTE) in TB cases, Case studies of MDR pulmonary TB with PTE, Clinical presentation and diagnostic imaging in TB-related PTE, Treatment modalities for TB-related PTE (anticoagulants, thrombolytics), Thrombophilia workup in TB patients with PTE, Hypercoagulable state in tuberculosis, Mechanisms of venous thrombosis in TB patients, Rifampin's role in venous thrombosis, Review of literature on PTE in TB cases in India, Risk factors for PTE in MDR TB patients

Abstract

Background: Pulmonary tuberculosis (PTB) is an established cause of arterial and  venous thrombosis. With the rising incidence of multidrug-resistant tuberculosis (MDR TB), which has a prolonged treatment course, pulmonary thromboembolism in such cases further complicates the treatment outcome in terms of mortality and morbidity. TB causes systemic hypercoagulability, which may lead to both arterial and venous thrombosis. Therefore, it is important for treating physicians to be aware of the entity and have a sharp watch for the development of Pulmonary thromboembolism in cases of MDR TB.

The Case: We present the association of pulmonary thromboembolism (PTE) with MDR TB in three young males who developed pulmonary thromboembolism during the treatment of MDR TB, along with their management using anticoagulant agents.

Conclusion: PTE in cases of TB is rare but fatal. High suspicion of PTE in patients with MDR TB will help in diagnosing the dreaded condition early and aid in reducing preventable mortality with PTE. Early recognition, prompt diagnosis, and management is the key to saving the lives of those with this fatal complication.

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References

Chakaya J, Khan M, Ntoumi F, Aklillu E, Fatima R, Mwaba P, Kapata N, Mfinanga S, Hasnain SE, Katoto PD, Bulabula AN. Global Tuberculosis Report 2020–Reflections on the Global TB burden, treatment and prevention efforts. Int J Infect Dis. 2021;113:S7-S12.

Prasad R, Gupta N, Banka A. Multidrug-resistant tuberculosis/rifampicin-resistant tuberculosis: Principles of management. Lung India. 2018;35(1):78-81.

Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of hospitalization for venous thromboembolism. Circulation. 2012;125(17):2092-9.

Hirsh J, Hoak J. Management of deep vein thrombosis and pulmonary embolism: a statement for healthcare professionals from the council on thrombosis (in consultation with the council on cardiovascular radiology), American Heart Association. Circulation. 1996;93(12):2212-45.

Prandoni P, Bernardi E, Marchiori A, Lensing AW, Prins MH, Villalta S, Bagatella P, Sartor D, Piccioli A, Simioni P, Pagnan A. The long-term clinical course of acute deep vein thrombosis of the arm: prospective cohort study. BMJ. 2004;329(7464):484-5.

Robson SC, White NW, Aronson I, Woollgar R, Goodman H, Jacobs P. Acute‐phase response and the hypercoagulable state in pulmonary tuberculosis. Br. J. Haematol. 1996;93(4):943-9.

Aguirre B, ME AS. Tuberculosis as a risk factor for venous thrombosis. An Med Interna. 1993;10(8):398-400.

Ambrosetti M, Ferrarese M, Codecasa LR, Besozzi G, Sarassi A, Viggiani P, Migliori GB. Incidence of venous thromboembolism in tuberculosis patients. Respiration. 2006;73(3):396.

Ogawa T, Uchida H, Kusumoto Y, Mori Y, Yamamura Y, Hamada S. Increase in tumor necrosis factor alpha-and interleukin-6-secreting cells in peripheral blood mononuclear cells from subjects infected with Mycobacterium tuberculosis. Infect Immun. 1991;59(9):3021-5.

Gauldie J, Northemann W, Fey GH. IL-6 functions as an exocrine hormone in inflammation. Hepatocytes undergoing acute phase responses require exogenous IL-6. J Immunol. 1990;144(10):3804-8.

Gogna A, Pradhan GR, Sinha RS, Gupta B. Tuberculosis presenting as deep vein thrombosis. Postgrad Med J. 1999;75(880):104-5.

Kumar V, Gupta KB, Aggarwal R. Deep vein thrombosis in tuberculosis. J Infect Dis Antimicrob Agents. 2011;28:63–7.

Naithani R, Agrawal N, Choudhary VP. Deep venous thrombosis associated with tuberculosis. Blood Coagul Fibrinolysis. 2007;18(4):377-80.

Sharma RR, Acharya KV, Poornima V. A rare complication of pulmonary tuberculosis. J. Indian Acad. Clin. Med. 2007;8(2):179-181.

Shah PA, Yaseen Y, Malik AH. Pulmonary Tuberculosis with Deep Venous Thrombosis. WebmedCentral GENERAL MEDICINE 2011;2(8): WMC002093.

Mohan B, Kashyap A, Whig J, Mahajan V. Pulmonary embolism in cases of pulmonary tuberculosis: a unique entity. Indian J Tuberc. 2011;58(2):84-7.

Sangani J, Mukherjee S, Biswas S, Chaudhuri T, Ghosh G. Tuberculosis and acute deep vein thrombosis in a pediatric case. Journal of Clinical and Diagnostic Research: JCDR. 2015;9(6):SD01.

Muley P, Shah U, Shah V, Gandhi D. Deep vein thrombosis with tuberculosis: A rate presentation of common disease. Global J Med Public Health. 2014;3(1).

CT Pulmonary Angiogram Showing Thrombo-Embolism in he Right Pulmonary Trunk.

Published

2023-12-21

How to Cite

Marwah , V., Bhati , G., Chaudhary , R., & Sharma, A. (2023). Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management. International Journal of Medical Students, 11(4), 321–325. https://doi.org/10.5195/ijms.2023.1996

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Case Report

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