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Chatterjee R, Sinha S, Sarkar K, Gonjhu D, Pal S, Pramanik N. Deep Vein Thrombosis in a Patient of Extrapulmonary Tuberculosis. INTERNATIONAL JOURNAL OF RECENT SURGICAL AND MEDICAL SCIENCES 2022. [DOI: 10.1055/s-0041-1734212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAmong the various complications reported to be caused by tuberculosis (TB), thrombogenic potential is a rare entity. Here, we report a case of colonic tuberculosis in a 30-year-old male who developed left upper limb deep vein thrombosis (DVT). Ruling out other possible causes of DVT and improvement of the affected limb with antitubercular drugs led to conclusion that DVT was most probably due to TB.
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Affiliation(s)
- Rupak Chatterjee
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Sumanta Sinha
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Kumkum Sarkar
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Debananda Gonjhu
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Sekhar Pal
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
| | - Netai Pramanik
- Department of Tropical Medicine, School of Tropical Medicine, Kolkata, West Bengal, India
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Subahi EA, Alawad MJ, Abdelmahmuod EA, Sibira D, Kamal I. Pulmonary Tuberculosis With Saddle Pulmonary Embolism and Deep Vein Thrombosis: A Rare Case Report. Cureus 2021; 13:e15958. [PMID: 34336453 PMCID: PMC8315083 DOI: 10.7759/cureus.15958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2021] [Indexed: 11/15/2022] Open
Abstract
Pulmonary tuberculosis is a common endemic disease in developing countries but its thrombogenic tendency is not well-studied and established yet. Pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. There are reports stating the relation of pulmonary embolism (PE) and deep vein thrombosis (DVT) with a severe infection of tuberculosis but no data is available to establish a mutual association between pulmonary tuberculosis and pulmonary thromboembolism. Herein, we report the case of a 51-year-old male who presented with a one-month history of productive cough, shortness of breath, and fever associated with chills and night sweating. He reported an 8 kg weight loss in the last month. He was found to have pulmonary tuberculosis. On further investigations for leg swelling and tachycardia. Deep vein thrombosis and sub-massive saddle bilateral pulmonary embolism were diagnosed, which was treated with thrombolysis therapy (alteplase). He responded well to initial therapy and was discharged on anticoagulation with anti-tuberculous therapy (ATT).
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Affiliation(s)
- Eihab A Subahi
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
| | | | | | - Dalal Sibira
- Radiology Department, Hamad Medical Corporation, Doha, QAT
| | - Ijaz Kamal
- Internal Medicine Department, Hamad Medical Corporation, Doha, QAT
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Vega-Moreno DA, Aviles-Aguilar A, de la-Torre AI, Aguilar-Calderón JR, García-González U, Santellán-Hernández JO, Betancourt-Quiroz C, Dueñas-Espinoza MA, González-González IE, Molina-Martínez RP, Ochoa-Cacique D. Intracranial hypertension syndrome secondary to internal jugular vein thrombosis due to miliary cervical tuberculosis: A case report. Surg Neurol Int 2021; 12:32. [PMID: 33598348 PMCID: PMC7881519 DOI: 10.25259/sni_885_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Thrombosis of the internal jugular vein (IJV) is extremely rare, being central catheterization the most common cause. We present a case of a patient with an unusual appearance of neurological symptoms as a consequence of thrombosis of the IJV secondary to miliary tuberculosis. Case Description: A 30-year-old woman with disseminated tuberculosis, with multiple lymphadenopathy, axillary, cervical, mesenteric, retroperitoneal, and inguinal, presented with clinical evidence of intracranial hypertension. A diagnostic cerebral angiography was performed, which revealed an occluded left internal jugular and venous stasis in the entire cerebral venous system. The patient was treated with low-molecular-weight heparin, with which she had an adequate evolution. Conclusion: Tuberculosis is capable of generating a state of hypercoagulability, in addition to a mechanical compression effect due to cervical lymphadenopathy. We report an unusual clinical presentation, with intracranial involvement due to IJV thrombosis secondary to miliary tuberculosis. So far, there are no cases with a similar presentation described above.
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Affiliation(s)
| | | | | | | | - Ulises García-González
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
| | | | | | | | | | | | - Diego Ochoa-Cacique
- Department of Neurosurgery, Hospital Central Sur de Alta Especialidad, Mexico City, Mexico
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Thromboembolic complications associated with tuberculosis: A pediatric case report. ACTA ACUST UNITED AC 2020; 40:587-593. [PMID: 33275336 PMCID: PMC7808783 DOI: 10.7705/biomedica.5195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Indexed: 11/29/2022]
Abstract
La tuberculosis es una de las enfermedades infecciosas más comunes en el mundo. Aunque la mortalidad en niños es prácticamente nula cuando el diagnóstico y el tratamiento son oportunos, puede asociarse con complicaciones como la trombosis venosa profunda y la superficial a partir de la respuesta inflamatoria sistémica frente a la infección, lo que propicia la coagulación y ocasiona una significativa morbimortalidad. Se reporta el caso de una adolescente de 14 años con tuberculosis pulmonar en tratamiento combinado quien, de forma atípica, presentó dos episodios de tromboembolia venosa: el primero en el riñón y el segundo en los pulmones. Tras descartar el síndrome nefrótico y el antifosfolipídico, los estudios de tomografía de tórax y abdomen fueron una herramienta fundamental para su diagnóstico. Se inició tratamiento con heparina de bajo peso molecular con mejoría de los síntomas. Teniendo en cuenta las necesidades de anticoagulación no fue posible realizar estudios adicionales de ampliación. Las complicaciones tromboembólicas en pacientes con tuberculosis y sin otros factores de riesgo obligan a considerar el efecto coagulante que resulta de la reacción inflamatoria sistémica, la cual podría, por sí sola, ser la causa de una complicación significativa pero prevenible, aunque frecuentemente escapa al diagnóstico. En este sentido, se recomienda considerar la posibilidad de la tromboembolia venosa en estos pacientes y hacer un seguimiento estricto que permita aplicar el tratamiento anticoagulante tempranamente y prevenir, así, resultados adversos.
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Elleuch N, Sabbek A, Hammami A, Ksiaa M, Jmaa A. Primary peritoneal tuberculosis, a forgotten etiology of portal vein thrombosis. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:96-98. [PMID: 32265024 DOI: 10.1016/j.jdmv.2020.01.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- N Elleuch
- Faculty of medicine of Sousse, Department of gastroenterology, hospital Sahloul, University of Sousse, Sousse, Tunisia.
| | - A Sabbek
- Faculty of medicine of Sousse, Department of gastroenterology, hospital Sahloul, University of Sousse, Sousse, Tunisia
| | - A Hammami
- Faculty of medicine of Sousse, Department of gastroenterology, hospital Sahloul, University of Sousse, Sousse, Tunisia
| | - M Ksiaa
- Faculty of medicine of Sousse, Department of gastroenterology, hospital Sahloul, University of Sousse, Sousse, Tunisia
| | - A Jmaa
- Faculty of medicine of Sousse, Department of gastroenterology, hospital Sahloul, University of Sousse, Sousse, Tunisia
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Hariz A, Guermazi M, Hamdi MS, Boukhris I. Deep vein thrombosis of the left arm revealing an asymptomatic pulmonary tuberculosis. BMJ Case Rep 2019; 12:12/6/e229484. [PMID: 31160302 DOI: 10.1136/bcr-2019-229484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although not frequent, thromboembolic events occurring in patient presenting tuberculosis may be observed. Frequency of such thromboembolic events seems correlated with the severity of tuberculosis. We herein report a case of venous thrombosis revealing an asymptomatic tuberculosis. A man aged 32 years was admitted for deep and superficial vein thrombosis of the left arm. Chest CT angiography ruled out pulmonary embolism and showed a mediastinal and pulmonary heterogeneous necrotic mass at the apical segment of the left lung. Histological study of a CT scan-guided pulmonary biopsy showed signs of caseating granuloma compatible with tuberculosis. Diagnosis of venous thrombosis due to pulmonary tuberculosis with lymph nodes involvement was made. Antituberculosis treatment was initiated and required an adjustment of anticoagulant therapy. Our observation highlights the possibility of causative effect between tuberculosis and venous thrombosis.
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Affiliation(s)
- Anis Hariz
- Universite de Tunis El Manar Faculte de Medecine de Tunis, Tunis, Tunisia.,Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia.,Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Mouna Guermazi
- Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Salah Hamdi
- Universite de Tunis El Manar Faculte de Medecine de Tunis, Tunis, Tunisia.,Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
| | - Imen Boukhris
- Internal Medicine, Charles Nicolle Hospital, Tunis, Tunisia
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Ha H, Kim KH, Park JH, Lee JK, Heo EY, Kim JS, Kim DK, Choi IS, Chung HS, Lim HJ. Thromboembolism in Mycobacterium tuberculosis Infection: Analysis and Literature Review. Infect Chemother 2019; 51:142-149. [PMID: 31270993 PMCID: PMC6609750 DOI: 10.3947/ic.2019.51.2.142] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 03/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background Tuberculosis is associated with hypercoagulation; however, there are few reports of cases thromboembolism and tuberculosis at the same time in the real world. The purpose of this study was to report the incidence and clinical course of thromboembolism in patients diagnosed with tuberculosis. Materials and Methods We retrospectively analyzed the data of patients who were diagnosed with both tuberculosis and thromboembolism including pulmonary thromboembolism (PTE) or deep vein thrombosis (DVT) at Seoul National University Boramae Medical Center from January 2000 through March 2015. Results Among the 7905 tuberculosis patients, 49 (0.6%) exhibited PTE, DVT, or both at or after the time of tuberculosis diagnosis. All patients treated for tuberculosis started with isoniazid, ethambutol, rifampicin, and pyrazinamide. Eight patients were switched to treatment with second-line medication because of resistance or adverse events. About half of the patients (n = 21, 44.7%) had thrombosis at the time of tuberculosis diagnosis. Of 48 patients treated for thromboembolism, 36 received warfarin. A total of 20 patients improved symptom caused by thrombosis, and 10 patients were confirmed cure by image study such as computed tomography or doppler ultrasonography. Eight patients who were treated with warfarin had persistent thrombosis. Five patients (10.2%) experienced major bleeding that required hospitalization. All of these bleeding events were associated with warfarin therapy. Conclusions Careful attention to PTE/DVT is needed at the time of diagnosis of tuberculosis and during anti-tuberculosis therapy. Warfarin therapy administered with anti-tuberculosis medication requires frequent monitoring to prevent major bleeding.
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Affiliation(s)
- Hyerim Ha
- Division of Hematology and Medical Oncology, Department of Internal medicine, Seoul National University Hospital, Seoul, Korea.,Division of Hematology and Medical Oncology, Department of Internal medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, Incheon, Korea
| | - Ki Hwan Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
| | - Jin Hyun Park
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung Kyu Lee
- Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Eun Young Heo
- Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jin Soo Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Deog Kyeom Kim
- Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - In Sil Choi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Soon Chung
- Division of Pulmonology, Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hyo Jeong Lim
- Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
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Abstract
Tuberculosis (TB) affects the production and life span of all hematologic cellular components. In addition, plasma coagulation factors may be affected, resulting in sometimes life-threatening complications. Iron, folate, and vitamin B12 metabolism is derailed. The pharmacological agents used for TB therapy may also cause hematologic changes. There are some uncommon manifestations of TB in nontuberculous hematologic patients. There have been some exciting developments in the field of imaging to screen for TB, TB pathophysiology at the cellular level, and our understanding of immune response in TB. Advances have been made in pharmacologic therapeutic options, including discovery of new drugs in the fight against drug-resistant TB, bearing in mind their hematologic effects. This chapter reviews and updates known hematologic effects of TB and its therapy and some lesser known effects of TB in patients with nontuberculous hematologic conditions.
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Roy S, Bhatt S, Rawal R, Tandon A, Meena N. Splenic Vein Thrombosis as a Rare Complication of Disseminated Tuberculosis - Imaging Diagnosis and Case Report. Pol J Radiol 2017; 82:106-109. [PMID: 28344684 PMCID: PMC5335783 DOI: 10.12659/pjr.900198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 07/18/2016] [Indexed: 11/27/2022] Open
Abstract
Background Venous thromboembolism is a known but rare complication associated with Mycobacterium tuberculosis infection. The reported incidence of venous thromboembolism is 1.5–3.4% of infected patients, and it occurs due to a hypercoagulable state induced by the associated inflammation. Case Report A young woman with pulmonary tuberculosis was found to have disseminated tuberculosis and a clinically unsuspected partial thrombus in the splenic vein on imaging. Ultrasound demonstrated hepato-splenomegaly with multiple granulomas as well as ascites and a left-sided pleural effusion. An increased calibre of the splenic vein with a hyperechogenicity within it raised the suspicion of a thrombus, which was confirmed on a contrast-enhanced CT examination. CECT of the abdomen also showed a small peripheral splenic infarct, while CECT of the chest revealed bilateral miliary lesions in the lungs along with necrotic mediastinal lymphadenopathy. The final imaging diagnosis was disseminated tuberculosis complicated by splenic vein thrombosis. A timely institution of anti-coagulant and anti-tubercular treatment led to a complete resolution of the splenic vein thrombosis. Conclusions Contrast-enhanced CT serves as a useful imaging tool for the detection of venous thrombosis and for the estimation of a complete burden of the disease. This condition should be kept in mind by both clinicians and radiologists and looked for in order to prevent life-threatening complications.
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Affiliation(s)
- Satarupa Roy
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Shuchi Bhatt
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Rajesh Rawal
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Anupama Tandon
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
| | - Neha Meena
- Department of Radiology, University College of Medical Sciences (Delhi University) and Guru Teg Bahadur Hospital, Dilshad Gardens, India
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Internal Jugular Vein Thrombosis in Isolated Tuberculous Cervical Lymphadenopathy. Case Rep Radiol 2016; 2016:5184196. [PMID: 27900225 PMCID: PMC5120177 DOI: 10.1155/2016/5184196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/23/2016] [Indexed: 11/30/2022] Open
Abstract
Tuberculosis is a common infectious disease with a high prevalence in developing countries and presents a major public health issue. Internal jugular vein (IJV) thrombosis is a rare complication in tuberculous cervical lymphadenopathy. We report a case of 26-year male patient with a history of low-grade evening rise in fever, dry cough, loss of appetite, and loss of weight with swelling in lower neck on right side. Ultrasonography (USG) neck showed well-defined hypoechoic lymph nodes posterior to right IJV and common carotid artery in the lower neck at level IV and in the right supraclavicular region showing central necrotic areas with adjoining IJV thrombosis. The association between tuberculosis and deep vein thrombosis is rare. Awareness of IJV thrombosis in isolated cervical lymphadenopathy needs high diagnostic suspicion and prompt treatment to avoid fatal complication. Our case is rare as there was isolated tuberculous cervical lymphadenopathy with adjoining IJV thrombosis. Both USG and computed tomography (CT) are accurate and reliable radiological investigations for detecting IJV thrombosis along with cervical lymph nodes. They are useful in assessing surrounding soft tissue and fat planes and knowing the size and extent of cervical lymphadenopathy. USG is inexpensive and readily available for monitoring response to treatment.
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Awolesi D, Naidoo M, Cassimjee MH. The profile and frequency of known risk factors or comorbidities for deep vein thrombosis in an urban district hospital in KwaZulu-Natal. South Afr J HIV Med 2016; 17:425. [PMID: 29568604 PMCID: PMC5843052 DOI: 10.4102/sajhivmed.v17i1.425] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022] Open
Abstract
Background Although deep vein thrombosis (DVT) is a preventable disease, it increases the morbidity and mortality in hospitalised, patients, resulting in considerable economic health impact. The identification and primary prevention of risk factors using risk assessment and stratification with subsequent anti-thrombotic prophylaxis in moderate- to severe-risk categories is the most rational means of reducing morbidity and mortality. Aim and setting The aim of the study was to describe the profile and frequency of known risk factors or comorbidities of hospitalised medical patients with ultrasound-diagnosed DVT in an urban district hospital in KwaZulu-Natal. Methods A retrospective review of clinical notes of all medical patients (age ≥ 13 years) admitted to the hospital with ultrasound-diagnosed DVT between July and December 2013. Results The median age was 40 years (interquartile range 32–60 years) and female preponderance was 72.84%. HIV and tuberculosis emerged as the prevalent risk factors, accounting for 51.85% and 35.80%, respectively. Other risk factors observed were recent hospitalisation (34.57%), smoking (25.93%), previous DVT (19.75%) and congestive cardiac failure (18.52%). Conclusion DVT in our study occurred predominantly in young female patients unlike previous studies where patients were generally older. Furthermore, HIV and tuberculosis were the two most common known risk factors or comorbidities observed. Clinicians should have a heightened awareness of venous thromboembolism in patients with either condition or where both conditions occur together and appropriate thromboprophylaxis should be administered.
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Affiliation(s)
- Damilola Awolesi
- Department of Family Medicine, University of KwaZulu-Natal, South Africa
| | - Mergan Naidoo
- Department of Family Medicine, University of KwaZulu-Natal, South Africa
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Park SY, Lee SM, Shin JW, Choi BW, Kim H, Lee JS, Lee SD, Park SS, Moon HS, Park YB. Epidemiology of chronic thromboembolic pulmonary hypertension in Korea: results from the Korean registry. Korean J Intern Med 2016; 31:305-12. [PMID: 26689916 PMCID: PMC4773708 DOI: 10.3904/kjim.2014.122] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/04/2014] [Accepted: 04/28/2015] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/AIMS The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) is difficult for numerous reasons and is related with a poor prognosis. In Korea, the incidence of CTEPH and its clinical features are unknown. Thus, in this study, we evaluated the clinical characteristics and outcomes of CTEPH in a Korean cohort. METHODS This study included South Korean patients diagnosed with CTEPH between September 2008 and October 2011. Baseline characteristics, treatments and outcomes were analyzed. RESULTS A total of 134 patients were included in this study with 76 females (56.7%). Their median age was 58.3 ± 15.9 years and dyspnea (112 patients, 83.5%) was the most common presenting symptom. Sixty-three patients (47%) had a history of acute pulmonary embolism or deep vein thrombosis, and six (4.5%) had pulmonary tuberculosis. In total, 28 patients (21%) underwent pulmonary thromboendarterectomy (PTE), and 99 patients had medical therapy. During the study period, 18 patients (13.4%) died. In a multivariate analysis, higher hemoglobin (relative risk [RR], 1.516; 95% confidence interval [CI], 1.053 to 2.184; p = 0.025) and lower total cholesterol levels (RR, 0.982; 95% CI, 0.965 to 0.999; p = 0.037) were associated with increased mortality. CONCLUSIONS This was the first national cohort study of Korean patients with CTEPH. Accurate diagnosis, characterization and distributions of CTEPH are imperative for prompt treatment in patients, particularly those undergoing PTE.
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Affiliation(s)
- So Young Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital and Lung Research Institute, Hallym University College of Medicine, Seoul, Korea
| | - Sang Min Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Wook Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Byoung Whui Choi
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hojoong Kim
- Division of Pulmonary Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Seung Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung Soo Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,Korea
| | - Hwa Sik Moon
- Department of Internal Medicine, College of Medicine, St. Paul’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yong Bum Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Hallym University Kangdong Sacred Heart Hospital and Lung Research Institute, Hallym University College of Medicine, Seoul, Korea
- Corresponding Author: Correspondence to Yong Bum Park, M.D. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital and Lung Research Institute, Hallym University College of Medicine, 150 Seongan-ro, Gangdong-gu, Seoul 05355, Korea Tel: +82-2-2224-2213 Fax: +82-2-2478-6925 E-mail:
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Mohan B, Chhabra ST, Gulati A, Mohan Mittal C, Mohan G, Tandon R, Kumbkarni S, Aslam N, Sood NK, Wander GS. Clinical and echocardiographic diagnosis, follow up and management of right-sided cardiac thrombi. Indian Heart J 2015; 65:529-35. [PMID: 24206876 DOI: 10.1016/j.ihj.2013.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 05/08/2013] [Accepted: 08/10/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Right-sided cardiac masses are infrequent and have varied clinical presentation. The present study describes the clinical features, echocardiographic findings and management of 19 patients presenting with right-sided cardiac thrombi in a tertiary care center in north India. METHODS This is a retrospective, single center observational study of consecutive patients over the period January 2003-2008 admitted in our emergency intensive care unit (EICU). We identified 38 patients with right-sided cardiac masses admitted to EICU diagnosed by transthoracic echocardiography of which 19 patients had right-sided thrombus. The echocardiographic findings were reviewed by two cardiologists in all patients. Treatment was not standardized and choice of therapy was based on judgment of attending physician. RESULTS The mean age of patients with cardiac thrombus was 36.6 ± 11.8 years. Right atrial (n = 17) and right ventricle (n = 2) thrombi were associated with deep vein thrombosis (DVT) in 7 (36.8%) and pulmonary embolism in 3 (15%) patients. 13 (68.4%) patients appeared to have in situ mural thrombus. 12 patients were managed with oral anticoagulants, 3 patients underwent surgery and 4 patients were thrombolysed. All the survivors had a mean follow-up of 40 ± 6 months (range--18-50 months). CONCLUSIONS Prompt echocardiographic examination in an appropriate clinical setting facilitates faster diagnosis and management of patients with right-sided cardiac thrombi. High incidence of in situ mural thrombus and varied comorbidities predisposing to right-sided cardiac thrombi besides DVT and pulmonary embolism need to be recognized. Oral anticoagulation and thrombolysis appear to be the mainstay of treatment with surgery limited for selected patients.
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Affiliation(s)
- Bishav Mohan
- Department of Cardiology, Dayanand Medical College & Hospital, Unit Hero DMC Heart Institute, Ludhiana, Punjab, India.
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Lombardi R, Pelusi S, Airaghi L, Fargion S. Extrapulmonary tuberculosis: an unusual presentation in an immunocompetent patient. BMJ Case Rep 2015; 2015:bcr-2014-207146. [PMID: 25948843 DOI: 10.1136/bcr-2014-207146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 50-year-old Brazilian woman was admitted to our department because of pelvic pain irradiated to the lower left limb, ipsilateral ankle swelling and progressive weight loss. Doppler ultrasound demonstrated deep venous femoropopliteal thrombosis, while a thorax-abdomen CT scan showed multiple solid hypodense pulmonary lesions, a large hypodense lesion in the iliopsoas muscles bilaterally and a complex cystoid lesion at the hepatic hilum. These findings were better characterised as active inflammatory colliquated lymph nodes by positron emission tomography and echo-guided percutaneous fine-needle aspiration of the left iliopsoas abscessual lesion finally allowed the diagnosis of tubercular infection with positive cultures for Mycobacterium tuberculosis complex.
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Affiliation(s)
- Rosa Lombardi
- Department of Internal Medicine, Ospedale Maggiore Policlinico Regina Elena Milano, Milan, Italy
| | - Serena Pelusi
- Department of Internal Medicine, Ospedale Maggiore Policlinico Regina Elena Milano, Milan, Italy
| | - Lorena Airaghi
- Department of Internal Medicine, Ospedale Maggiore Policlinico Regina Elena Milano, Milan, Italy
| | - Silvia Fargion
- Department of Internal Medicine, Ospedale Maggiore Policlinico Regina Elena Milano, Milan, Italy
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Kumarihamy KWMPP, Ralapanawa DMPUK, Jayalath WATA. A rare complication of pulmonary tuberculosis: a case report. BMC Res Notes 2015; 8:39. [PMID: 25888831 PMCID: PMC4328059 DOI: 10.1186/s13104-015-0990-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 01/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pulmonary tuberculosis remains an important public health problem globally and one of the most prevalent infectious diseases in Sri Lanka. It can cause a wide variety of complications but hematological manifestations are rare. According to our literature survey, this is the first reported case of the disease associated with deep vein thrombosis in Sri Lanka. CASE PRESENTATION A 37 year old Sri Lankan Sinhalese female presented with fever of one month's duration with productive cough and two weeks painless left lower limb swelling. Chest X-ray showed bilateral inflammatory shadows with a cavitatory lesion on the right apical region. A computed tomographic pulmonary angiography scan excluded pulmonary embolism. She had rising mycoplasma antibody titre (four fold). Acute deep vein thrombosis of the left lower limb was confirmed by venous duplex. Pulmonary tuberculosis was confirmed with positive culture for Mycobacterium tuberculosis. She was treated with clarythromycin, enoxaparin, warfarin and anti tuberculus drugs. It was difficult to maintain her International Normalizing Ratio in the therapeutic range due to drug interactions and poor compliance. At five months of presentation she died of massive pulmonary embolism. CONCLUSION Our case emphasizes that patients with severe pulmonary tuberculosis are at risk of developing thromboembolism and superadded infections. It should be noted that even though starting anti tuberculosis drugs improved haemostatic disturbances, achieving the target International Normalizing Ratio was difficult due to drug interactions. Therefore these patients should be closely followed up to prevent complications and death from pulmonary embolism.
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Kager LM, Blok DC, Lede IO, Rahman W, Afroz R, Bresser P, van der Zee JS, Ghose A, Visser CE, de Jong MD, Tanck MW, Zahed ASM, Alam KM, Hassan M, Hossain A, Lutter R, Veer CV, Dondorp AM, Meijers JCM, van der Poll T. Pulmonary tuberculosis induces a systemic hypercoagulable state. J Infect 2014; 70:324-34. [PMID: 25455017 DOI: 10.1016/j.jinf.2014.10.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 09/22/2014] [Accepted: 10/13/2014] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Human tuberculosis (TB) remains an important cause of death globally. Bangladesh is one of the most affected countries. We aimed to investigate the impact of pulmonary TB on pro- and anticoagulant mechanisms. METHODS This prospective study was conducted in Chittagong, Bangladesh. We performed an in-depth analysis of coagulation activation and inhibition in plasma obtained from 64 patients with primary lung TB and 11 patients with recurrent lung TB and compared these with 37 healthy controls. Additionally, in nine patients coagulation activation was studied in bronchoalveolar lavage fluid (BALF) harvested from the site of infection and compared with BALF from a contralateral unaffected lung subsegment. RESULTS Relative to uninfected controls, primary and recurrent TB were associated with a systemic net procoagulant state, as indicated by enhanced activation of coagulation (elevated plasma levels of thrombin-antithrombin complexes, D-dimer and fibrinogen) together with impaired anticoagulant mechanisms (reduced plasma levels of antithrombin, protein C activity, free protein S, and protein C inhibitor). Activation of coagulation did not correlate with plasma concentrations of established TB biomarkers. Coagulation activation could not be detected at the primary site of infection in a subset of TB patients. CONCLUSIONS Pulmonary TB is associated with a systemic hypercoagulable state.
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Affiliation(s)
- Liesbeth M Kager
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands.
| | - Dana C Blok
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Ivar O Lede
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Wahid Rahman
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Rumana Afroz
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Paul Bresser
- Department of Pulmonology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jaring S van der Zee
- Department of Pulmonology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Pulmonology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Aniruddha Ghose
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Caroline E Visser
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Menno D de Jong
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Medical Microbiology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Michael W Tanck
- Department Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Abu Shahed M Zahed
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Khan Mashrequl Alam
- Department of Microbiology, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Mahtabuddin Hassan
- Department of Internal Medicine, Chittagong Medical College & Hospital (CMCH), Chittagong, Bangladesh
| | - Ahmed Hossain
- Chest Disease Clinic Chittagong (CDCC), Chittagong, Bangladesh
| | - Rene Lutter
- Department of Pulmonology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Cornelis Van't Veer
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Arjen M Dondorp
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Centre for Tropical Medicine, Churchill Hospital, University of Oxford, Oxford, UK
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Department of Vascular Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands; Division of Infectious Diseases, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
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Ekukwe NC, Bain LE, Jingi AM, Sylvia K, Mintom P, Menanga A. Bilateral pulmonary embolism in a patient with pulmonary tuberculosis: a rare association in Yaoundé, Cameroon. Pan Afr Med J 2014; 17:262. [PMID: 25309662 PMCID: PMC4189908 DOI: 10.11604/pamj.2014.17.262.4107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 03/20/2014] [Indexed: 11/22/2022] Open
Abstract
Pulmonary embolism is a complication of pulmonary tuberculosis that has received little emphasis in the literature. We describe a 52 year old male, with no risk factors for thromboembolic disease referred to our service for an in depth clinical review for cardiomegaly and dyspnea on exertion. Echocardiography and CT scans revealed dilated heart cavities and bilateral proximal pulmonary emboli respectively and a cavitation in the apical lobe of the right lung. Bronchial aspirate and culture revealed the presence of mycobacterium tuberculosis. There was no evidence of malignancy. Elsewhere, a clinical review and a lower limb ultrasound showed no evidence of deep venous thrombosis. Clinical course on anti - tuberculosis and anti - coagulant therapies was remarkably favorable. Clinicians need to be conscious of the risk of developing thromboembolic disease in patients treated for tuberculosis, in especially high prevalence settings like ours.
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Affiliation(s)
- Nkoke Clovis Ekukwe
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon
| | | | - Ahmadou Musa Jingi
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon
| | - Kotta Sylvia
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon
| | - Pierre Mintom
- Department of Internal Medicine, Yaoundé General Hospital, Yaoundé, Cameroon
| | - Alain Menanga
- Faculty of Medicine and Biomedical Sciences, Department of Internal Medicine, Yaoundé, Cameroon ; Department of Internal Medicine, Yaoundé General Hospital, Yaoundé, Cameroon
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Kouismi H, Laine M, Bourkadi JE, Iraqi G. Association of deep venous thrombosis with pulmonary tuberculosis. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2013. [DOI: 10.1016/j.ejcdt.2013.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Bueno Filho R, Cordeiro AP, Almeida FTD, Shaletich C, Costa RS, Roselino AMF. Rare association of cutaneous vasculitis, IgA nephropathy and antiphospholipid antibody syndrome with tuberculous lymphadenitis. Clinics (Sao Paulo) 2012; 67:1497-500. [PMID: 23295608 PMCID: PMC3521817 DOI: 10.6061/clinics/2012(12)24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Roberto Bueno Filho
- University of São Paulo, School of Medicine of Ribeirão Preto, Department of Medical Clinics, Division of Dermatology, Ribeirão Preto/SP, Brazil
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Liu A, Hu Y, Coates A. Sudden cardiac death and tuberculosis – How much do we know? Tuberculosis (Edinb) 2012; 92:307-13. [DOI: 10.1016/j.tube.2012.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 02/07/2012] [Indexed: 12/13/2022]
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Incidence of Thromboembolism in Hospitalized Patients With Tuberculosis and Associated Risk Factors. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2012. [DOI: 10.5812/archcid.13950] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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22
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Aissa I, Rachdi I, Ben Miled K, Ghedira H. [Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:129-135. [PMID: 21665075 DOI: 10.1016/j.pneumo.2010.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2009] [Revised: 02/15/2010] [Accepted: 04/27/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.
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Affiliation(s)
- I Aissa
- Service de pneumologie I, Pavillon I, hôpital Abderrahman Mami, Ariana, Tunisie. imen
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Goncalves IM, Alves DC, Carvalho A, do Ceu Brito M, Calvario F, Duarte R. Tuberculosis and Venous Thromboembolism: a case series. CASES JOURNAL 2009; 2:9333. [PMID: 20066058 PMCID: PMC2804722 DOI: 10.1186/1757-1626-2-9333] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Accepted: 12/16/2009] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. CASE SERIES PRESENTATION We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. CONCLUSION An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.
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Affiliation(s)
- Ivone M Goncalves
- Pneumology Department, Vila Nova de Gaia/Espinho Hospital Centre, Porto, Portugal
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Deep venous thrombosis associated with antiphospholipid antibodies following tuberculosis lymphadenitis in a predisposed patient. Blood Coagul Fibrinolysis 2009; 19:464-5. [PMID: 18600102 DOI: 10.1097/mbc.0b013e328304e056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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