A case of concomitant pulmonary embolism and pulmonary tuberculosis in the era of COVID 19, a matter of cautious approach

Abstract

Tuberculosis (TB) is known to the world for many years. It is associated with various complications and rarely with pulmonary embolism. However, due to its commonalities of presenting features with COVID 19, it can easily be missed and may be life threatening.

A rare case of miliary tuberculosis presenting with saddle pulmonary embolism

“…A meta-analysis from 2021 analyzing 16,190 patients found an odds ratio of 2.9 for the development of VTE and 3.58 for the development of PE [ 2 ]. There have been case reports of saddle PE associated with TB as reported by Subahi et al [ 6 ] and Dakhlia et al [ 7 ]. However, in these two case reports the patients were diagnosed with TB first and subsequently developed PE.…”

A Case of Pulmonary Tuberculosis, Severe Dengue, and COVID-19 With Venous Thromboembolism in an Indian Male: World's First Case

“…In another retrospective analysis, out of 7905 patients diagnosed with TB, 0.6% exhibited PTE, deep venous thrombosis (DVT), or both i.e., VTE on or after the diagnosis of TB [10]. Hypercoagulability, venous stasis, and endothelial dysfunction constituting Virchow's triad could be the possible causes of VTE in TB [11].…”

“…Other important contributors could be TB's thrombogenic state which encompasses reactive thrombocytosis, anemia, and the release of pro-inflammatory cytokines damaging the vascular endothelium during the disease process [11]. Another notable point for a hypercoagulable state is the imbalance in the pro-coagulant and anticoagulant factors such as increased fibrinogen, factor VIII plasminogen activator inhibitor 1 plasma levels, and depressed anti-thrombin III and protein C levels in the initial months of management for TB [11]. However, due to oversaturated labs and lack of free slots during the third wave of COVID-19 these tests were not done in the present case.…”