Indian Journal of Respiratory Care

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VOLUME 13 , ISSUE 1 ( January-March, 2024 ) > List of Articles

CASE REPORT

A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report

Annapurna Mydavolu, Junaid Ahmed, Thippeswamy Gowda

Keywords : Case report, Cough, Effusion, Hemoptysis, Normal D-dimer, Pneumonia, Pulmonary embolism, Pulmonary infarct, Pleural effusion

Citation Information : Mydavolu A, Ahmed J, Gowda T. A Rare Coexistence of Pneumonia and Pulmonary Infarct with a Normal D-dimer Acute Pulmonary Thromboembolism: A Case Report. Indian J Respir Care 2024; 13 (1):60-63.

DOI: 10.5005/jp-journals-11010-1091

License: CC BY-NC 4.0

Published Online: 06-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Although pneumonia is associated with an increased risk of venous thromboembolism, patients with pulmonary embolism (PE) and concomitant pneumonia are uncommon. In this case report, we present a 40-year-old male patient with pneumonia and PE in whom pneumonia initially masked the diagnosis of PE. Moreover, pneumonia may occasionally mask PE, particularly in patients with predominant systemic symptoms such as fever, and with no evidence of deep vein thrombosis (DVT) or trauma. Case presentation: This patient who is an industrial worker, smoker and alcoholic presented to the ER with acute left lower chest and upper abdominal pain, shortness of breath, high grade fever and cough with hemoptysis. On examination pulse rate was 118 and normal oxygen saturation. He was admitted to the intensive care unit (ICU) and managed conservatively. His ultrasound chest and chest X-ray showed left lower lobe consolidation with effusion. His Wells score is 2.5, and D-dimer is normal, but total leucocyte counts and hemoglobin are elevated. There no signs of DVT. He was managed with intravenous antibiotics, antipyretics. He has no signs of hemodynamic instability or hypoxia. He had persistent blood clots in sputum, which warranted computed tomography (CT) pulmonary angiography. Acute pulmonary thromboembolism (PTE) with pulmonary infarct (PI) and concomitant consolidation with pleural effusion is reported. Venous Doppler study of both lower limbs was negative for deep venous thrombosis except for a slow flow vascular malformation in the left distal thigh. He was started on anticoagulation with low molecular weight heparin as per treatment guidelines for 6 days, later he improved and had no hemoptysis or any bleeding. Further investigations for hypercoagulable state done that showed high levels of serum homocysteine and low folic acid. With the advice of oral anticoagulation and folic acid supplementation, he was discharged from the hospital in a stable condition. This case is a rare entity of normal D dimer PTE with PI. This case highlights the importance of considering PE in patients with pneumonia when there would be an initial therapeutic response followed by a worsening of the condition during the treatment of pneumonia. Conclusion: When approaching an otherwise young and healthy individual with unexplained pleuritic chest pain or hemoptysis in the emergency department, a pulmonary infarction (PI) complicating an acute PE should be considered as a possible diagnosis among other conditions (e.g., pneumonia, lung neoplasia, lung granulomatous disease), when there is a strong clinical suspicion.


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