Title: Inferior Vena Caval Thrombosis in Elderly Patients with Active Pulmonary Tuberculosis: A Case Series with Implications for Therapy
Authors: Afshan Shabir, Parvaiz Koul
DOI: http://dx.doi.org/10.18535/jmscr/v3i9.42
Introduction: Prevalence of tuberculosis continues to remain high worldwide According to 2010 Global Burden of Disease estimates, majority of tuberculosis related deaths occurred in people older than 50. Tuberculosis (TB) is associated with a hypercoagulable state and hence VTE. These can be extensive and potentially life threatening. A variety of factors have been postulated to predispose patients with tuberculosis to venous thrombosis that include local stasis due to venous compression by lymph nodes and relative immobility caused by respiratory dysfunction, alteration in coagulation factors and reactive thrombocytosis. Conclusion: Our two cases highlight the risk of deep venous thrombosis in elderly patients with pulmonary tuberculosis even in the absence of any other risk factors for VTE. TB should be considered as a risk factor for VTE and included in thromboembolism risk evaluation especially in first few months of treatment. VTE might be the first presentation of underlying tuberculosis. Also, VTE associated with tuberculosis might be extensive and involve proximal veins hence, may be life threatening due to a higher risk of pulmonary embolism. Physicians must be aware of this for prompt diagnosis and treatment to prevent fatality. Patients on tubercular therapy might require high doses of anticoagulation due to known interaction 1. World Health Organization (WHO), "Global tuberculosis report," 2014. 2. Artiles Vizcaíno,Balda Aguirre,Melado Sánchez, Arkuch Saade,Ayala Galán Saturnino Suárez Ortega, "Tuberculosis as risk factor for venous thrombosis," An Med Interna, vol. 10, no. 8, pp. 398-400, 1993. 3. White NW, "Venous Thrombosis and rifampicin," Lancet, vol. 2, pp. 434-435, 1989. 4. Ferrarese M, Codecasa L, Besozzi G, Sarassi A, Viggiani P, Migliori G Ambrosetti M, "Incidence of Venous Thromboembolism in Tuberclosis Patients," Respiration, vol. 73, p. 396, 2006. 5. Kunter E, Solmazgul E, Cerrahoglu K, Ilvan A Turken O, "Hemostatic Changes in active Pulmonary Tuberclosis," international journal of tuberculosis and lung disease, vol. 6, no. 10, pp. 927-932, 2002. 6. White NW, Aronson I, Woolgar R, Goodman H, Jacobs P Robson SC, "Acute-phase Response And The Hypercoagulable State in Pulmonary Tuberclosis," British Journal of Hematology, vol. 93, pp. 943-949, 1996. 7. Yawar Yaseen, Abdul H Malik Parvaiz A Shah, "Pulmonary Tuberculosis with Deep Venous Thrombosis," General Medicine, Case Report 2011. 8. Urjita Shah, Varsha Shah, Dulari Gandhi Prasad Muley, "Deep Vein Thrombosis With Tuberculosis: A Rate Presentation of Common Disease," GLOBAL JOURNAL OF MEDICINE AND PUBLIC HEALTH, vol. 3, no. 1, 2014. [Online]. www.gjmedph.org 9. Neerja Agrawal, Ved P Choudhary Rahul Naithani, "Deep venous thrombosis associated with tuberculosis," Blood Coagulation & Fibrinolysis, vol. 18, no. 4, pp. 377-380, June 2007. 10. Banerjee AK, Vasishta RK, Marwaha N, Deodhar SD Kakkar N, "Aseptic Cerebral Venous Thrombosis Associated With Abdominal Tuberculosis," Neurol India, vol. 51, no. 1, pp. 128-129, 2003. 11. Lalla R, Patil TB, Tiwari N Verma R, "A Rare Presentation of Cerebral Venous Sinus Thrombosis Associated With Tubercular Meningitis.," BMJ Case Rep PMC3761660, 2013. 12. Veena Chowdhury, K Rajeshwari Jyoti Kumar, Arab Journal of Gastroenterology, vol. 14, no. 2, pp. 85-86, June 2013. 13. Agarwal A Mithun Raj, "Inferior Vena Cava Thrombosis Complicating uberculosis," The Newzeland Medical Journal, vol. 119, no. 1244, p. U2279, Oct 2006. 14. Serebrianaia BA, Martynova EV, Mishin VI. Kaminskaia GO, "Intravascular Coagulation As a Typical Concomitant of Acute Pulmonary Tuberculosis," Problemy Tuberkuleza, vol. 3, pp. 42-46, 1997. 15. Jesús Rios, Antonio Sánchez-Porto, and Manuel Casanova-Bellido Manuel Casanova-Román, "Deep Venous Thrombosis Associated with Pulmonary Tuberculosis and Transient Proteins Deficiency," Scandinavian Journal of Infectious Diseases, vol. 34, no. 5, pp. 393-394, 2002. 16. G R Pradhan, R S K Sinha, B Gupta A Gogna, "Tuberculosis Presenting As Deep Vein Thrombosis," Postgraduate Medical Journal, vol. 75, pp. 104-106, 1999. 17. R B Mann T H Self, "Interaction of Rifampin And Warfarin," Chest, vol. 67, no. 4, pp. 490-491, 1975.Abstract
Case series presentation: We report 2 cases of extensive venous thromboembolism associated with pulmonary tuberculosis in the elderly. A 65 year-old Asian female with recently diagnosed tuberculosis presented with a new long deep vein thrombus extending from tibial vein up to right heart chamber and 67 year old Asian male in whom VTE was a presenting feature of tuberculosis (CFV thrombus extending up to IVC). Inferior vena caval thrombosis has been reported only rarely in active pulmonary tuberculosis and only 3 reports exist in English literature References