A Patient of Anti-phospholipid Syndrome and Pulmonary Tuberculosis with Cor Pulmonale: A Case Report and Prospective Treatment

Abstract

A 27-year-old male presented with progressive dyspnea and productive cough with whitish sputum for several months. Severe central and peripheral cyanosis and leg edema were also noted. Right heart failure was diagnosed based on echocardiograph findings, and pulmonary thromboembolism was suspected due to elevated D-dimer level. Anti-phospholipid syndrome was diagnosed based on the elevation of anti-cardiolipin immunoglobulin G, and nifedipine, enoxaparin, furosemide, and continuous oxygen were given as initial treatment. Bilateral pulmonary fibrothorax was noted on Chest X-ray, and pulmonary tuberculosis was confirmed by positive sputum acid fast stain. The patient was discharged with improvement in dyspnea and cyanosis after isolation for anti-tuberculosis medication. Finally, his condition improved significantly during the year following hospitalization, and pulmonary artery pressure returned to normal after the complete anti-tuberculosis treatment course and long-term oral anticoagulant treatment. Consequently, prompt diagnosis and appropriate medication, including anti-TB medication, anticoagulant drug, and continuous oxygen, are essential to improve clinical prognosis of cor pulmonale due to reversible etiologies such as pulmonary tuberculosis and chronic pulmonary thromboembolism.