title: A rare complication of pulmonary tuberculosis: a case report.
abstract: BACKGROUND
  Pulmonary tuberculosis remains an important public health problem globally and one of the most prevalent infectious diseases in Sri Lanka. It can cause a wide variety of complications but hematological manifestations are rare. According to our literature survey, this is the first reported case of the disease associated with deep vein thrombosis in Sri Lanka.
  
  
  METHODS
  A 37 year old Sri Lankan Sinhalese female presented with fever of one month's duration with productive cough and two weeks painless left lower limb swelling. Chest X-ray showed bilateral inflammatory shadows with a cavitatory lesion on the right apical region. A computed tomographic pulmonary angiography scan excluded pulmonary embolism. She had rising mycoplasma antibody titre (four fold). Acute deep vein thrombosis of the left lower limb was confirmed by venous duplex. Pulmonary tuberculosis was confirmed with positive culture for Mycobacterium tuberculosis. She was treated with clarythromycin, enoxaparin, warfarin and anti tuberculus drugs. It was difficult to maintain her International Normalizing Ratio in the therapeutic range due to drug interactions and poor compliance. At five months of presentation she died of massive pulmonary embolism.
  
  
  CONCLUSIONS
  Our case emphasizes that patients with severe pulmonary tuberculosis are at risk of developing thromboembolism and superadded infections. It should be noted that even though starting anti tuberculosis drugs improved haemostatic disturbances, achieving the target International Normalizing Ratio was difficult due to drug interactions. Therefore these patients should be closely followed up to prevent complications and death from pulmonary embolism.
authors.affiliation: University Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka. prabhashinikumarihamy@yahoo.com.
authors.forename: Kulatunga Wijekoon Mudiyanselage Pramitha Prabhashini
authors.initials: KW
authors.lastname: Kumarihamy
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.
authors.forename: Dissanayake Mudiyanselage Priyantha Udaya Kumara
authors.initials: DM
authors.lastname: Ralapanawa
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. thilakj@gmail.com.
authors.forename: Widana Arachchilage Thilak Ananda
authors.initials: WA
authors.lastname: Jayalath
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004336:Drug Antagonism; D017984:Enoxaparin / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007866:Leg / Q000098:blood supply / Q000382:microbiology / Q000473:pathology; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D011655:Pulmonary Embolism / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D017211:Treatment Failure; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D020246:Venous Thrombosis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000995:Antitubercular Agents; D017984:Enoxaparin; D014859:Warfarin; D017291:Clarithromycin