Thromboembolic Sequelae in Extrapulmonary Tuberculosis: A Rare Case of Extensive Iliofemoral Deep Vein Thrombosis and Bilateral Pulmonary Embolism in a Young Adult

Abstract Tuberculosis (TB), a chronic granulomatous infection, is associated with systemic inflammation that may unmask a hypercoagulable state. While venous thromboembolism (VTE) in TB has been sporadically reported, its occurrence in young, immunocompetent individuals without conventional risk factors remains underrecognized. We describe a 22-year-old male on treatment for extrapulmonary TB (pleural effusion) who presented with right lower limb swelling and breathlessness. Imaging revealed extensive iliofemoral and tibial deep vein thrombosis (DVT), along with bilateral pulmonary emboli. The patient responded well to anticoagulation with apixaban alongside continued antitubercular therapy. The coexistence of extensive iliofemoral DVT and bilateral pulmonary embolism (PE) in a young adult with extrapulmonary TB is exceedingly rare. Fewer than 50 cases of TB-associated VTE have been reported in the literature, with even fewer involving such proximal extensive DVT and PE in the absence of additional risk factors. This case underscores the need for heightened clinical suspicion and early imaging in TB patients presenting with thromboembolic symptoms, regardless of immune status or traditional risk factors.