Hyperhomocysteinemia and Pulmonary Embolism Without Deep Vein Thrombosis in a Young Patient Presenting as Pneumonia - A Rare Case Report

Abstract

We report a 40 year old male who presented with fever, dyspnoea, right sided pleuritic chest pain and hemoptysis. His physical examination and chest X-ray revealed features of right sided consolidation with pleural effusion. Worsening of his condition despite adequate antibiotic therapy prompted us to consider an alternative cause. Repeat ECG after 3 days showed S1q3T3 pattern. CT angiogram evidenced thrombus in right pulmonary artery and doppler study of both the lowerlimbs showed normal superficial and deep venous system. Hypercoagulation workup revealed high levels of homocysteine. This is a rare case report of hyperhomocysteinemia presenting as pulmonary embolism without documented deep vein thrombosis, and the patient presented with classical clinical and radiological findings of pneumonia.