Pulmonary Tuberculosis Induced Coagulation Disorder - A Case Series.

Abstract

Active pulmonary tuberculosis may be complicated by deep vein thrombosis, pulmonary embolism ,cardiac ischemic events , associated with a hypercoagulable state secondary to the inflammatory state due to 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). Often pulmonary tuberculosis patient  associated with  reactive thrombocytosis due to increased levels of interleukin 6 the degree of thrombocytosis correlates significantly with the degree of inflammation (21) its also act as attributed risk for hypercoagulability state , Vascular complications associated with infection by Mycobacterium tuberculosis have been reported in the literature that occurred in 1.5–3.4% of TB infection [1], One‑third of patients with symptomatic venous thromboembolism (VTE) manifest pulmonary embolism, whereas two‑thirds manifest deep vein thrombosis (DVT). Overall, 25%–50% of patients with first‑time VTE have an idiopathic condition, without a readily identifiable risk factor, and its association with tuberculosis (TB) is a rare occurrence. Deep venous thrombosis has been associated with 1.5%–3.4% cases of TB. Early initiation of anti‑TB treatment along with anticoagulant therapy decreases the overall morbidity and mortality associated with the disease. We report Four cases of DVT with pulmonary embolism and one case of ischemic cardiac events (myocardial infarction) associated with pulmonary TB  ,who were diagnosed due to high index of suspicion as the risk factors for the development of coagulation disorder were present in these cases.