Fatal deep venous thrombosis and pulmonary embolism secondary to melioidosis in China: case report and literature review

Abstract Background Burkholderia pseudomallei is a gram-negative bacterium and the causative pathogen of melioidosis, which manifests a variety ranges of infection symptoms. However, deep venous thrombosis (DVT) and pulmonary embolism (PE) secondary to bacteremic melioidosis are rarely documented in the literature. Herein, we reported a fatal case of melioidosis combined with DVT and PE. Case presentation A 54-year-old male construction worker and farmer with a history of diabetes was febrile, painful in left thigh, swelling in left lower limb, with chest tightness and shortness of breath for 4 days. He was later diagnosed as DVT of left lower extremity and PE. The culture of his blood, sputum and bone marrow samples grew B. pseudomallei. The subject was administrated with antibiotics (levofloxacin, cefoperazone/tazobactam, and imipenem) according to antimicrobial susceptibility testing and low molecular heparin for venous thrombosis. However, even after appropriate treatment, the patient deteriorated rapidly, and died 2 weeks after admission. Conclusions This study enhanced awareness of the risk of B. pseudomallei bloodstream infection in those with diabetes. If a patient has predisposing factors of melioidosis, when DVT is suspected, active investigation and multiple therapeutic interventions should be implemented immediately to reduce mortality rate.

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A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis

Case Reports in Medicine ◽

10.1155/2016/7527098 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Peter V. Bui ◽

Maan Moualla ◽

Dona J. Upson

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Lower Extremity ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Single Case ◽

The United States ◽

Middle Lobe ◽

History Of ◽

Right Middle Lobe

Introduction.3,3′-Diindolylmethane is available as a supplement in the United States for “cancer prevention” and “augmentation of physical fitness.” A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism.Case Presentation.A 65-year-old man presented with swelling, erythema, and warmth of his right lower extremity for three to four weeks. He had been taking diindolylmethane one tablet daily for three to four months. Risk factors for venous thromboembolism included tobacco use, personal history of possible pulmonary embolism, body mass index, and age. Imaging studies found extensive deep venous thrombosis in his right lower extremity and bilateral pulmonary embolism with probable right middle lobe infarction. Follow-up imaging showed chronic deep venous thrombosis in his right lower extremity.Discussion.As suggested in this single case, patients who take diindolylmethane may be at greater risk for venous thromboembolism. Further reports and studies are necessary in order to elucidate this possible association. Clinicians should question patients about supplements in the setting of venous thromboembolism.

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ID: 47: TESTOSTERONE-HCG THERAPY ASSOCIATED WITH RECURRENT DEEP VENOUS THROMBOSIS-PULMONARY EMBOLISM DESPITE ANTICOAGULATION IN A 55 YEAR OLD MAN WITH THROMBOPHILIA

Journal of Investigative Medicine ◽

10.1136/jim-2016-000120.79 ◽

2016 ◽

Vol 64 (4) ◽

pp. 950.3-951

Author(s):

K Lee ◽

CJ Glueck

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

White Male ◽

Serum Testosterone ◽

Normal Serum ◽

Testosterone Therapy ◽

Case Presentation ◽

One Year ◽

Hcg Therapy

BackgroundWhen exogenous testosterone or treatments to elevate testosterone (human chorionic gonadotropin [HCG] or Clomid) are given to men with underlying familial and/or acquired thrombophilia, deep venous thrombosis and pulmonary embolism often occur, and may recur despite adequate anticoagulation if testosterone therapy is continued.Case PresentationIn a 55 year old white male, referred to us because of 4 thrombotic events, 3 despite adequate anticoagulation over a 5 year period, we assessed interactions between thrombophilia, exogenous testosterone therapy, and recurrent thrombosis. In 2009, despite low-normal serum testosterone 334 ng/dl (lower normal limit [LNL] 300 ng/dl.), he was given testosterone (TT) cypionate (50 mg/week) and HCG (500 units/week) for presumed hypogonadism. Ten months later, with supranormal serum T (1385 ng/dl, UNL 827 ng/dl) and estradiol (E2) 45 pg/ml (UNL 41 pg/ml), he had a pulmonary embolus (PE), and was then anticoagulated for 2 years (enoxaparin, then Coumadin). Four years later, on TT-HCG, he had his first deep venous thrombosis (DVT). TT was stopped, HCG continued; he was anticoagulated (enoxaparin, then Coumadin, then apixaban (Eliquis), then fondaparinux (Arixtra)). One year after his first DVT, on HCG, still on Arixtra, he had a second DVT (5/2015), was anticoagulated (enoxaparin+Coumadin), with a Greenfield filter placed, but 8 days later had a second PE. The Lupus anticoagulant was found to be present. After stopping HCG, and maintained on Coumadin, he has been free of further DVT-PE for 6 months.ConclusionWhen DVT- PE occur on TT or HCG, in the presence of thrombophilia, TT- HCG should be stopped, lest DVT-PE reoccur despite concurrent anticoagulation.

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A History of Pulmonary Embolism and Deep Venous Thrombosis

Critical Care Clinics ◽

10.1016/j.ccc.2008.12.014 ◽

2009 ◽

Vol 25 (1) ◽

pp. 115-131 ◽

Cited By ~ 7

Author(s):

Kenneth E. Wood

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

History Of

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Can’t Dissolve Me Now: A COVID-19 Provoked Venous Thromboembolism Breaks Through Apixaban: Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.3.50505 ◽

2021 ◽

Vol 2 (5) ◽

pp. 202-205

Author(s):

Alexander Arena ◽

Ahmad Hussein ◽

Ellen Kurkowski ◽

Miriam Kulkarni

Keyword(s):

Emergency Department ◽

Pulmonary Embolism ◽

Case Report ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Optimal Dosage ◽

History Of

Introduction: Coronavirus disease 2019 (COVID-19) is a multisystem process with a growing evidence of its endotheliopathy effects, with subsequent hypercoagulability states. Case Report: WWe present an emergency department case of a COVID-19-provoked deep venous thrombosis and pulmonary embolism without a history of venous thromboembolism (VTE), with extension of the VTE despite adherence to apixaban. Conclusion: This case demonstrates the importance of further research and protocols for optimal dosage and treatment to prevent worsening VTE in COVID-19 patients.

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Deep Venous Thrombosis of the Legs after Strokes: Incidence, Natural History and Predisposing Factors

10.1055/s-0039-1689543 ◽

1975 ◽

Cited By ~ 1

Author(s):

Charles Warlow ◽

D. Ogston ◽

A. S. Douglas

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Past History ◽

Cerebrovascular Accidents ◽

X Ray ◽

Clinical Criteria ◽

Vein Thrombosis ◽

History Of ◽

Chest X Ray

Forty of 76 patients who had sustained a cerebro-vascular’ accident developed a deep venous thrombosis of the paralysed leg as detected by the 125I-fibrinogen technique. A further 5 also had a thrombosis in the non-paralysed leg. ‘Definite’ pulmonary embolism, diagnosed at necropsy or by unequivocal clinical criteria, occurred in 9.2% of patients and ‘probable’ embolism, diagnosed on clinical examination and chest x-ray only, occurred in another 6.6% of patients Within the limitations of the 125I-fibrinogen technique it appeared that, in patients after cerebrovascular accidents, thrombosis developed in several independent sites in the venous system of the legs and propagation of the thrombi took place in both a distal and proximal direction. Pulmonary embolism occurred, with one exception, only in patients with detectable leg vein thrombosis.None of the risk factors studied including age, sex, obesity, side of paralysis, past history of venous thromboembolism, neurological and cardiac states, and interval between onset of stroke and mobilisation was helpful in predicting the likelihood of development of venous thrombosis in the paralysed limb.

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Association of Short-Term Mortality of Venous Thromboembolism with Family History of Venous Thromboembolism and Charlson Comorbidity Index

Thrombosis and Haemostasis ◽

10.1055/s-0038-1676347 ◽

2018 ◽

Vol 119 (01) ◽

pp. 048-055 ◽

Cited By ~ 1

Author(s):

Bengt Zöller ◽

MirNabi Pirouzifard ◽

Jan Sundquist ◽

Kristina Sundquist

Keyword(s):

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Family History ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Charlson Comorbidity Index ◽

Short Term ◽

Short Term Mortality ◽

History Of ◽

Comorbidity Index

AbstractStudies on short-term prognosis of venous thromboembolism (VTE) that take family history of VTE and Charlson Comorbidity Index (CCI) into account are sparse. The aim was to investigate the importance of family history of VTE and CCI for short-term mortality after a first episode of VTE. Using Swedish medical databases, we conducted a 90-day nationwide cohort study of 41,700 Swedish born patients with a first-time VTE (July 2005–August 2012). Patients diagnosed with VTE and prescribed anticoagulant treatment were included. Mortality hazard ratios (HRs) with 95% confidence intervals (CIs) were determined with Cox regression. Patients with first-degree (sibling/parent) family history of VTE (n = 11,405, 27.4%) had significantly lower CCI than those without family history. Independent risk factors for 90-day mortality in the adjusted model were: female sex (HR = 1.19, 95% CI: 1.09–1.29), increasing age (HR = 1.02, 95% CI: 1.01–1.02 per year), pulmonary embolism (HR = 1.21, 95% CI: 1.11–1.32) or combined pulmonary embolism and deep venous thrombosis (HR = 1.60, 95% CI: 1.27–2.01) compared with deep venous thrombosis, CCI = 1 (HR = 2.93, 95% CI: 2.32–3.72), CCI = 2 (HR = 8.65, 95% CI: 7.16–10.46) or CCI = 3 (HR = 22.25, 95% CI: 18.73–26.44) compared with CCI = 0. Having one or two or more affected first-degree relatives with VTE was associated with lower mortality, HR = 0.83 (95% CI: 0.74–0.92) and HR = 0.65 (95% CI: 0.51–0.85), respectively. The mortality rate was 0.70% in patients with a CCI of zero. In receiver operating characteristic (ROC) analysis, the area under the ROC curve for CCI was 0.84 (0.83–0.95). Family history of VTE is associated with lower mortality while CCI is a strong predictor for short-term mortality in VTE. Co-morbidities are important for risk assessment of VTE.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

Author(s):

Piecuch ◽

Wiewiora ◽

Nowowiejska-Wiewiora ◽

Szkodzinski ◽

Polonski

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Retroperitoneal Hematoma ◽

Ivc Filter ◽

Filter Placement ◽

Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

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High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657711 ◽

1997 ◽

Vol 78 (04) ◽

pp. 1178-1182 ◽

Cited By ~ 59

Author(s):

Timo Palosuo ◽

Jarmo Virtamo ◽

Jari Haukka ◽

Philip R Taylor ◽

Kimmo Aho ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasma Proteins ◽

Alpha Tocopherol ◽

Index Number ◽

Thromboembolic Events ◽

Middle Aged ◽

Phospholipid Binding ◽

Antiprothrombin Antibodies

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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