PULMONARY VEIN THROMBOSIS IN TUBERCULOSIS PATIENT

SESSION TITLE: Pulmonary Vascular Disease Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm INTRODUCTION: Tuberculosis (TB) is a risk factor for developing venous thromboembolism. It is considered an independent factor for having a hypercoagulable state due to changes in the coagulation factors. Pulmonary vein thrombosis (PVT) is a rare condition but it's life-threatening. It can be associated with TB. Here, we are presenting a case of PVT in a patient who has TB. CASE PRESENTATION: A 79-year-old male who has past medical history significant for end-stage renal disease on hemodialysis, chronic hypoxia on home oxygen, essential hypertension, and type II diabetes. The patient presented to the emergency department with shortness of breath. He had a history of recurrent bloody left-side pleural effusion which needed multiple thoracenteses. Pleural fluid analysis showed evidence of exudative effusion. The patient also had a positive QuantiFERON TB Gold test twice. Previously and because he had recurrent pleural effusion, the decision was to start him on treatment for active TB. On presentation, he was hemodynamically stable. His labs on presentation were unremarkable except for elevated creatinine and BUN in addition to normocytic anemia which is mostly due to his end-stage renal disease. However, when the patient presented to the hospital, he has a computerized tomography (CT) scan–pulmonary embolism protocol showed evidence of left inferior pulmonary vein thrombus (as in the figure attached). The patient was not on anticoagulation before. He was started on heparin drip and then he was switched to oral anticoagulation apixaban. The patient had CT pulmonary embolism protocol a year ago showing patent pulmonary arteries and veins without evidence of thrombosis DISCUSSION: TB is considered an independent risk factor for VTE due to hypercoagulable state. Previously published studies suggested that 2 percent prevalence of VTE among TB patients. This is similar to VTE associated with malignancy. The main mechanism behind this is the higher level of fibrinogen and low level of antithrombin III and protein C. In our case, the patient was a known case of TB and he came to the hospital with dyspnea. CT was done as a part of a dyspnea workup and showed pulmonary vein thrombosis which is very rare. The patient did not have risk factors for thrombosis except active TB. PVT in TB is a rare condition that makes our case unique CONCLUSIONS: VTE is a known complication that can happen in TB patients. PVR is a rare complication that can happen in TB patients which should be in the differential diagnosis in known TB patients who present with unexplained respiratory symptoms REFERENCE #1: 1. Bansal, Sameer et al. "Systemic thrombosis due to pulmonary tuberculosis." The National medical journal of India vol. 30,4 (2017): 201-202. doi:10.4103/0970-258X.218672 REFERENCE #2: 2. Raru, Y., Abouzid, M., Zeid, F., & Teka, S. (2018). Pulmonary vein thrombosis secondary to tuberculosis in a non-HIV infected patient. Respiratory medicine case reports, 26, 91–93. https://doi.org/10.1016/j.rmcr.2018.11.020 REFERENCE #3: Dentan C., Epaulard O., Seynaeve D. Active tuberculosis and venous thromboembolism: association according to international classification of diseases, ninth revision hospital discharge diagnosis codes. Clin. Infect. Dis. 2014;58:495 DISCLOSURES: No relevant relationships by Mohammed Awad No relevant relationships by Hiba Hadid