Abstract
Background Pulmonary embolism (PE) is a medical emergency. Certain medications like oral contraceptives and hormone replacement therapies have been associated with PE. Clomiphene citrate is a selective estrogen receptor modulator, approved for treating infertility in females, but is being used as an off-label therapy in treating male hypogonadism. Very rarely, clomiphene can cause pulmonary embolism. Case Report. A 56-year-old gentleman presented with acute onset shortness of breath and chest discomfort. Upon further workup, he was found to have large volume pulmonary embolism. He was prescribed clomiphene citrate (CC) 2 years ago for hypogonadism. He was started on anticoagulation with improvement in his symptoms, and clomiphene was discontinued. Conclusion Pulmonary embolism is a rare but potential complication of clomiphene therapy. In male patients with suspected hypogonadism, the risk of serious thromboembolic complications should be discussed before prescribing CC. Patients on CC have to be carefully monitored for serious side effects.
Highlights
Venous thromboembolism (VTE) refers to blood clots in the veins and comprises deep vein thrombosis (DVT) and pulmonary embolism (PE)
Its use as off-label in male patients with hypogonadism has increased. e role of clomiphene in treating infertility among male patients is controversial. ere have been few cases reported in the literature relating increased risk of VTE in association with clomiphene citrate (CC). is includes reported cases of Pulmonary embolism (PE) [5, 6], central retinal vein occlusion [7,8,9], and rarely intracranial (IC) thrombosis [10]
Only two case reports have been described attributing CC to IC thrombosis [10, 11] even without other major risk factors and may have increased risk if they have other contributing factors. e two reported cases are seen in young males within few weeks of using off-label clomiphene for infertility/hypogonadism
Summary
Pulmonary embolism (PE) is a medical emergency. Certain medications like oral contraceptives and hormone replacement therapies have been associated with PE. Clomiphene citrate is a selective estrogen receptor modulator, approved for treating infertility in females, but is being used as an off-label therapy in treating male hypogonadism. A 56-year-old gentleman presented with acute onset shortness of breath and chest discomfort. Upon further workup, he was found to have large volume pulmonary embolism. He was found to have large volume pulmonary embolism He was prescribed clomiphene citrate (CC) 2 years ago for hypogonadism. He was started on anticoagulation with improvement in his symptoms, and clomiphene was discontinued. Pulmonary embolism is a rare but potential complication of clomiphene therapy. In male patients with suspected hypogonadism, the risk of serious thromboembolic complications should be discussed before prescribing CC. Patients on CC have to be carefully monitored for serious side effects
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