Pulmonary embolism during tuberculosis: clinical features and outcomes

Abstract

<b>Background:</b> Tuberculosis (TB) remains a major public health problem worldwide. Pulmonary embolism (PE) is rarely reported in TB but represents a therapeutic challenge <b>Objective:</b> Investigate clinical, paraclinical, and outcomes of the association between TB-PE <b>Methods:</b> Retrospective study of 776 cases of TB, 10 of which had PE (1.3%) between 2009 and 2023 <b>Results:</b> Our study involved 7 men and 3 women, 1 was HIV-positive and 1 had diabetes. There are 7 cases of pulmonary TB, 2 cases of miliary TB, one of which is associated with neuro meningeal TB, and a case of pleural TB. PE was seen during severe or disseminated TB: parenchymal damage was bilateral in 5 cases and 5 had cavities. PE was diagnosed within the first days TB in 7 cases or late in the course of the disease in 3 cases. Clinical signs were dominated by dyspnea (n=8) and chest pain (n=4). D-dimer testing performed in 3 cases was positive. All patients had hypoxemia of which 7 were in acute respiratory failure. PE was confirmed by thoracic angiography CT with bilateral damage (n=6), proximal (n=6), pulmonary hypertension (n=4), and 2 pulmonary infarctions. Anticoagulant treatment was instituted in all patients with heparin therapy, relayed by anti-vitamin K (n=9) and AODS (n=1). Due to the enzymatic-inducing effect of rifampin, a higher dose of oral anticoagulant was necessary to achieve therapeutic INR levels in 9 patients: 2mg (n=1), between 4mg and 8mg (n=5), 10mg (n=1), and 14mg (n=1). The delay in reaching the effective dose was 30 to 60days (n=7), 90days (n=1), and 315days (n=1). <b>Conclusions:</b> PE is associated with disseminated or severe TB forms. This association represents a therapeutic challenge justifying close biological controls and patient education