Severe pulmonary tuberculosis complicated with insidious pulmonary thromboembolism: a case report and literature review

Pulmonary thromboembolism (PTE) is an acute and severe disease with high mortality, which is prone to be misdiagnosed or ignored especially when complicated with tuberculosis (TB). Even though TB has been considered as a risk factor for PTE, there is rare report of TB with PTE worldwide. Which TB patients are more susceptible to PTE is still not clear. Here, we described a case report of PTE with pulmonary TB in a 28-year-old man, who had no risk factors for pulmonary thrombosis at admission and developed a medium-high PTE after initiating anti-TB therapy. After local thrombolysis with interventional therapy and sequential intravenous thrombolysis, combined with long-term anticoagulation, the PTE of the patient disappeared. At follow-up of 4 months, the patient was re-examined with chest enhanced CT and no obvious emboli was found. We emphasize that acute or severe TB infection should be included in the thromboembolism risk assessment and prophylactic use of anticoagulants may be considered even if there are no other obvious risk factors. Interventional therapy is a good option for thrombolysis treatment if hospital condition permits. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11239-019-01967-x) contains supplementary material, which is available to authorized users.