Co-existing tuberculosis and malignant mesothelioma with multiple sites venous thrombosis: a case report

Our plain-English summary of Co-existing tuberculosis and malignant mesothelioma with multiple sites venous thrombosis: a case report, by P. Kumar, K. Chawla, P. Khosla, et al (BMC Research Notes, 2016).

The study

• Authors: P. Kumar, K. Chawla, P. Khosla, S. Jain
• Journal: BMC Research Notes
• Published: 2016;9(1):409
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Tuberculosis is endemic in India and almost 40 % of the Indian population is infected with tubercle bacilli. Tuberculosis being a great mimicker of infectious as well as non infectious diseases and recent rise of multi drug resistant and extended drug resistant cases have made diagnosis and management more difficult. To the best of our knowledge there have been no reported cases of tuberculosis coexisting with malignant peritoneal mesothelioma leading to multiple site venous thrombosis.

Case Presentation: Forty five year old male, belonging to Indian/Aryan ethnicity presented with cough, breathlessness and fever for 7 months with past history of pulmonary tuberculosis. On examination he was found to have pleural effusion for which he received anti-tuberculosis therapy empirically. Later his condition deteriorated and on further examination he was found to have ascites, multiple site venous thrombosis and pyothorax which was found positive for acid fast bacilli. Despite anti-tuberculosis therapy he did not improve and was suspected to be a multidrug resistant case. Later on computed tomography peritoneal nodule was detected and on biopsy revealed malignant mesothelioma.

Conclusion: In a diagnosed case of tuberculosis with clinical findings compatible with it but not responding to anti tubercular therapy, underlying secondary co-existing pathology should be explored.

In plain English

This article was a case report about one patient, a 45-year-old man of Indian/Aryan ethnicity treated at Sir Gangaram Hospital in New Delhi, India. He had a past history of pulmonary tuberculosis. He had a dry cough, breathlessness and fever for 7 months. He was started on anti-tuberculosis drugs, but after 3 months his symptoms had not improved and his abdomen began to swell. Pus drained from his chest tested positive for acid fast bacilli, the germs seen in tuberculosis. Scans showed blood clots in several large veins and in the lungs. Fluid later drawn from his chest was chylous, and testing of it found no cancer. Biopsies of the omentum, a fatty layer in the abdomen, and of a lymph node showed malignant mesothelioma that had spread to the lymph node. The authors called it a peritoneal mesothelioma and stated that there was no asbestos exposure. He received carboplatin and pemetrexed while continuing tuberculosis treatment, and was discharged in stable condition. The authors could not attribute the clots to one disease. They concluded that when tuberculosis does not respond to treatment and presents unusually, another underlying disease must be explored.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: One 45-year-old man of Indian/Aryan ethnicity with a past history of pulmonary tuberculosis, referred to Sir Gangaram Hospital, New Delhi, India; HIV negative
• Exposure: The authors state the patient had no asbestos exposure; the report is about tuberculosis coexisting with peritoneal mesothelioma, not about an asbestos exposure
• Main results:
  • The patient's symptoms did not subside after 3 months of anti-tuberculosis therapy (rifampicin, isoniazid, ethambutol and pyrazinamide)
  • Pus drained from the patient's pleural cavity was positive for acid fast bacilli on Ziehl–Neelsen stain
  • The patient had venous thrombosis in the superior and inferior vena cava, the right internal jugular vein and both brachiocephalic veins; pulmonary thromboembolism was also noted
  • Chylous fluid aspirated from the patient's chest was negative for cancer on cytology and consistent with chylothorax
  • Omental and subdiaphragmatic lymph node biopsies showed malignant mesothelioma with nodal metastasis
  • The patient was given low dose chemotherapy with carboplatin and pemetrexed while anti-tuberculosis therapy continued, and was discharged in a clinically stable condition
• The authors' conclusion: The authors concluded that in a case of tuberculosis that does not respond to treatment and has an uncommon presentation, the possibility of a different underlying disease must be explored
• Limitations the authors state:
  • The authors state that the multiple venous thromboses could not be attributed to a single disease, because both mesothelioma and tuberculosis have been linked to thrombosis

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Endemic, Peritoneal Mesothelioma, Pleural Effusion, Ascites, Empyema, Biopsy, Pathology.

Related studies

• Commentary: Focused attention on proactive identification of deep venous thrombosis after pleurectomy/decortication for malignant pleural mesothelioma — S.S. Groth, R.T. Ripley, et al. (2020)
• Routine surveillance for diagnosis of venous thromboembolism after pleurectomy for malignant pleural mesothelioma — L.E. De León, C.E. Bravo-Iñiguez, et al. (2020)
• Malignant peritoneal mesothelioma associated with deep vein thrombosis following radiotherapy for seminoma of the testis — F. Sato, H. Yamazaki, et al. (2000)
• Environmental dangers: asbestos and tuberculosis — G. Hillerdal (2000)
• Tuberculosis and risk of cancer: a Danish nationwide cohort study — D.F. Simonsen, D.K. Farkas, et al. (2014)
• Pleural mesothelioma and venous thrombosis: the eosinophilia link — P.R. Ames, W.W. Aye (2008)

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