Pulmonary Thromboembolism in Multidrug-Resistant Tuberculosis: A Case Series Highlighting the Importance of Early Diagnosis and Management
DOI:
https://doi.org/10.5195/ijms.2023.1996Keywords:
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 patientsAbstract
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.
Metrics
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. DOI: https://doi.org/10.1016/j.ijid.2021.02.107
Prasad R, Gupta N, Banka A. Multidrug-resistant tuberculosis/rifampicin-resistant tuberculosis: Principles of management. Lung India. 2018;35(1):78-81. DOI: https://doi.org/10.4103/lungindia.lungindia_98_17
Rogers MA, Levine DA, Blumberg N, Flanders SA, Chopra V, Langa KM. Triggers of hospitalization for venous thromboembolism. Circulation. 2012;125(17):2092-9. DOI: https://doi.org/10.1161/CIRCULATIONAHA.111.084467
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. DOI: https://doi.org/10.1161/01.CIR.93.12.2212
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. DOI: https://doi.org/10.1136/bmj.38167.684444.3A
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. DOI: https://doi.org/10.1046/j.1365-2141.1996.d01-1722.x
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. DOI: https://doi.org/10.1159/000091188
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. DOI: https://doi.org/10.1128/iai.59.9.3021-3025.1991
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. DOI: https://doi.org/10.4049/jimmunol.144.10.3804
Gogna A, Pradhan GR, Sinha RS, Gupta B. Tuberculosis presenting as deep vein thrombosis. Postgrad Med J. 1999;75(880):104-5. DOI: https://doi.org/10.1136/pgmj.75.880.104
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. DOI: https://doi.org/10.1097/MBC.0b013e3280d942b4
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. DOI: https://doi.org/10.7860/JCDR/2015/11809.6078
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).
Published
How to Cite
License
Copyright (c) 2023 Vikas Marwah , Gaurav Bhati , Robin Chaudhary , Anmol Sharma
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to contact@ijms.org
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to contact@ijms.org