Abstract
In developed countries, tuberculosis remains a health care challenge due to human immunodeficiency virus (HIV) and immigration from endemic regions. The Centers for Disease Control and Prevention reported 9557 new cases in 2015, with extrapulmonary involvement in 20.2% of the cases. We present a 33-year-old woman from Cape Town, South Africa, who developed abdominal pain and fever while working on a cruise ship. She sought medical where she underwent computed tomography of her chest, abdomen, and pelvis with findings suggestive of pulmonary tuberculosis and an 8.9-cm pelvic mass. HIV testing was positive and the patient was started on antiretroviral therapy. Bronchoscopy confirmed the presence of acid-fast bacilli, and she was started on rifampin, isoniazid, pyrazinamide, and ethambutol. She remained persistently febrile, raising suspicion for immune reconstitution inflammatory syndrome. However, despite empiric antibiotics, the patient remained persistently febrile, tachycardic, and on day 10 of admission she went into ventricular fibrillation and expired. Autopsy revealed an occlusive thrombus in the left main pulmonary artery in addition to necrotizing granulomata in multiple organs and bilateral tubo-ovarian abscesses. Postmortem cultures for were positive for Mycobacterium tuberculosis, all consistent with disseminated Mycobacterium tuberculosis. Although previous reports underscore the association between tuberculosis and hypercoagulability, the exact mechanism remains unknown. In this article, we report a case of disseminated tuberculosis complicated by bilateral tubo-ovarian abscesses with fatal pulmonary thrombus formation.
Highlights
In developed countries, tuberculosis (TB) remains a health care challenge due to human immunodeficiency virus (HIV) and immigration from endemic regions
We report a interesting case of a patient with recently diagnosed HIV who was found to have bilateral adnexal masses as a presentation of disseminated TB, who died from a massive pulmonary embolism in the setting of immune reconstitution inflammatory syndrome (IRIS)-TB syndrome
There are case reports in the literature associating hypercoagulability with Mycobacterium tuberculosis infection: deep vein thrombosis associated with pulmonary TB, peritoneal TB with secondary portal vein thrombosis, and fatal massive pulmonary embolism despite receiving appropriate RIPE therapy and a therapeutic international normalized ratio.[13,14,15]
Summary
Tuberculosis (TB) remains a health care challenge due to human immunodeficiency virus (HIV) and immigration from endemic regions. This was a 33-year-old African woman from Cape Town, South Africa, who developed abdominal pain and fever while working on a cruise ship. She developed abdominal pain for 3 days She was treated for constipation but sought out medical care at the port when she reported new-onset subjective fevers. The patient was febrile but hemodynamically stable and comfortable in bed On arrival she underwent bronchoscopy to obtain bronchoalveolar lavage samples, which later on confirmed the presence of acid-fast bacilli, leading to immediate initiation of rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE). The patient was found to have necrotizing granulomata of the lungs, omentum,
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