Inferior Vena Caval Thrombosis in Elderly Patients with Active Pulmonary Tuberculosis: A Case Series with Implications for Therapy

Abstract

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. 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 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