Unmasking Thrombosis in Tuberculosis: Pulmonary Embolism in Active Pulmonary Tuberculosis— A Case Series

Background: Acute infections are well-recognized risk factors for venous thromboembolism (VTE); however, the contribution of chronic infections such as tuberculosis (TB) to pulmonary thromboembolism (PTE) remains underreported and likely underestimated.Increasing evidence suggests a prothrombotic state in active TB mediated by systemic inflammation and endothelial dysfunction.Methods: We describe a case series of three patients diagnosed with active pulmonary TB who developed concurrent PTE over 1 year at a tertiary care center.The study was conducted after obtaining approval from the scientific and ethical committee.Clinical presentation, radiological findings, laboratory parameters, including thrombophilia workup, management, and outcomes were analyzed.Results: All patients presented with worsening dyspnea disproportionate to radiological severity of TB.Diagnosis of PTE was confirmed by computed tomography pulmonary angiography (CTPA).Thrombophilia screening was negative in all cases, with no identifiable conventional risk factors for VTE.All patients were managed with standard anti-tubercular therapy (ATT) along with anticoagulation using low-molecularweight heparin (LMWH), followed by oral anticoagulants.Clinical improvement was observed in all patients, with no mortality.Conclusion: Pulmonary thromboembolism is a potentially underrecognized complication of active pulmonary TB.A high index of suspicion is warranted in TB patients with unexplained or disproportionate hypoxemia or clinical deterioration.Early diagnosis and prompt initiation of anticoagulation, alongside ATT, are critical to improving outcomes.