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Case Reports
. 2022 Sep 10:39:101736.
doi: 10.1016/j.rmcr.2022.101736. eCollection 2022.

A Case of Tuberculosis-related Cerebral Venous Sinus Thrombosis and Pulmonary Thromboembolism Successfully Treated with Edoxaban

Koichi Nishino  1   2 , Takashi Akimoto  1   2 , Hideyuki Mitsuoka  3 , Yutaka Terajima  4 , Yuta Arai  1   2 , Yoshihiro Masui  1   2 , Tomoyasu Mimori  1   2 , Kengo Koike  1   2 , Kazuhisa Takahashi  2 , Mitsuaki Sekiya  1   2
Affiliations
Case Reports

A Case of Tuberculosis-related Cerebral Venous Sinus Thrombosis and Pulmonary Thromboembolism Successfully Treated with Edoxaban

Koichi Nishino et al. Respir Med Case Rep. .

Abstract

A 22-year-old woman was admitted to the hospital with complaints of headache and vomiting. Radiological examinations revealed cerebral sinus venous thromboses, pulmonary thromboembolism, and cavities in the left upper lung. Pulmonary tuberculosis was diagnosed based on sputum and gastric aspirate culture. Heparin followed by warfarin was administered. Anti-tuberculosis agents including rifampicin were also initiated. Since the effect of warfarin did not reach the therapeutic level because of interaction with rifampicin, edoxaban was administered and thromboses were ameliorated. This report illustrates rare thrombotic complications in a TB-induced hypercoagulable state and the potential benefits and safety of edoxaban in combination with rifampicin.

Keywords: Cerebral venous sinus thrombosis; Direct oral anticoagulant; Edoxaban; Pulmonary thromboembolism; Pulmonary tuberculosis; Venous thrombosis.

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Conflict of interest statement

We have had no prior discussions with a Respiratory Medicine Case Reports Editorial Board Member about the work described in our manuscript. The manuscript has never been published and is not under consideration for publication elsewhere. All the authors have read the manuscript and approved this submission. The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Radiological findings on admission A. Chest radiography showing a left hilar protruding shadow (arrowhead). B. Chest computed tomography (CT) indicating thick-walled lesions with cavities in the left upper lung (arrowhead). C-D. Contrast-enhanced CT of the chest revealing thrombosis in bilateral pulmonary arteries (arrowheads) and left hilar lymphadenopathy (arrows). E. Head CT (sagittal view) demonstrating high-density lesions in the superior sagittal and straight sinus (arrowheads). F. Magnetic resonance venography (MRV) of the brain. Loss of venous signals is seen in the superior sagittal, transverse, and sigmoid sinus (arrows), suggestive of acute thrombosis.
Fig. 2
Fig. 2
Radiological findings at follow-up A-B. Contrast-enhanced CT of the chest three weeks after the admission. Note that marked amelioration of thromboses in bilateral pulmonary arteries (arrowheads). C. Chest radiography after completion of anti-tuberculous therapy showing shrinkage of the left hilar lymphadenopathy. D. MRV after completion of edoxaban therapy indicating recovery of the venous blood flow in the right cerebral venous sinuses (arrows).
See this image and copyright information in PMC

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