Massive Pulmonary Thromboembolism and Stroke

Poobalan Naidoo,Richard Hift

doi:10.1155/2011/398571

Abstract

A 38-year-old HIV-positive female, recently started on antiretroviral therapy, presented in extremis. She had features suggestive of an HIV-associated cardiomyopathy complicated by the following problems: a four-day-old stroke, extensive deep venous thrombosis, and massive pulmonary embolism. She received intravenous streptokinase with rapid improvement, both haemodynamically and, unexpectedly, neurologically. Our case illustrates that a positive outcome is potentially possible where the two conditions coincide.

Highlights

A 38-year-old HIV-positive female, recently started on antiretroviral therapy, presented in extremis. She had features suggestive of an HIV-associated cardiomyopathy complicated by the following problems: a four-day-old stroke, extensive deep venous thrombosis, and massive pulmonary embolism
The prothrombotic state in HIV-positive patients correlates with the severity of HIV-associated immunosuppression
Various abnormalities predisposing to a prothrombotic state have been reported, including the presence of antiphospholipid antibodies and lupus anticoagulant, deficiencies of protein C, protein S, heparin cofactor II, and antithrombin, and increased levels of von Willebrand factor and D-dimers [2, 3]

Summary

Poobalan Naidoo and Richard Hift

A 38-year-old HIV-positive female, recently started on antiretroviral therapy, presented in extremis She had features suggestive of an HIV-associated cardiomyopathy complicated by the following problems: a four-day-old stroke, extensive deep venous thrombosis, and massive pulmonary embolism. She received intravenous streptokinase with rapid improvement, both haemodynamically and, unexpectedly, neurologically. A repeat CT brain scan demonstrated a rim of enhancement around the infarction, reported as a haemorrhage, though subsequently suggested to represent an area of luxury perfusion She maintained her initial clinical improvement and improved further over subsequent days on standard therapy for heart failure.

Discussion

Findings

KING EDWARD VIII CT