Co-infection of Mycobacterium tuberculosis and Mycobacterium leprae Complicated by pulmonary embolism: A rare case report.

A 35-year-old male patient with lepromatous leprosy came to the emergency room (ER) due to breathlessness and chest pain. The patient was diagnosed with pulmonary tuberculosis (TB) after a bronchoscopy and started on antitubercular therapy. However, the patient continued to experience tachycardia and desaturation, and on further evaluation, Computed tomography pulmonary angiography revealed an embolus in the right descending pulmonary artery. The patient was found to have an elevated d-dimer. Further investigation revealed that the cause of the pulmonary thromboembolism (PTE) was the thalidomide medication that the patient was taking for type 2 leprosy reaction. The medication was stopped, and the patient was treated with low-molecular-weight heparin and discharged with apixaban for six months. The patient's condition improved on follow-up. This case is unique due to the rare combination of pulmonary TB, leprosy, and pulmonary embolism brought on by thalidomide administration. Physicians should be aware of the possibility of co-infection of TB and leprosy and the need to rule out thromboembolism when patients are on thalidomide.

Embolia pulmonar no decurso de reação hansênica / Pulmonary embolism in continuation of leprosy reaction

Uma jovem de 19 anos, doente de hanseníase do tipo virchoviano com surtos frequentes de reação hansênica (eritema nodoso), faleceu submitamente após 10 minutos de dispnéia, vômitos alimentares e dores fortes no tórax. A autópsia revelou trombose parcialmente organizada da veia cava inferior, de que originou tromboembolo ocluindo o tronco principal da artéria pulmonar, causa da morte súbita, com evidências de "cor pulmonale" agudo(hepatomegalia congestiva). Nenhuma das causas habituais de flebotrombose foi demonstrada. Os exames histopatológicos e bacterioscópicos, aliados a considerações imunopatológicas, levantam a possibilidade de que a embolia pulmonar estaria relacionada com a reação hansênica(eritema nodoso)