A 16-year-old female diagnosed a case of sputum-positive multidrug-resistant pulmonary TB presented to our hospital with complaints of swelling of the right leg for 1 month. The swelling had been initially progressive and associated with calf pain. The patient was not ambulatory due to severe dyspnea and weakness. Examination of the abdomen and cardiovascular system was unremarkable.
The local examination of the right limb showed a swollen and tender calf. The movements in the affected limb induced calf pain. Chest X-ray showed bilateral disease with fibrosis of the left lower zone [Figure 3].
USG Doppler of the peripheral veins of lower limbs revealed thrombosis of popliteal vein of the right lower limb [Figure 4]. USG of the abdomen was unremarkable. She was already on the second-line antitubercular drugs for the past 1 month. She was put on enoxaparin subcutaneously and warfarin. Since therapeutic international normalized ratio (INR) level was difficult to maintain with high doses (15 mg) of warfarin, acenocoumarol was initiated to maintain INR of 2.5 after stopping warfarin. The swelling in the limb subsided and patient was pain-free by the 10th day of admission. Subsequently, she was discharged after 30 days of hospital stay. Follow-up Doppler after 3 months showed partial resolution of the thrombus.