Think before prescribing oral contraceptive pills - pulmonary embolism in an obese hypertensive woman: a case report.

INTRODUCTION AND

IMPORTANCE

This case highlights the importance of suspicion of pulmonary embolism (PE) even after low-dose combined oral contraceptive pills (LD-OCPs) and early diagnosis and prompt thrombolytic therapy administration, especially in resource-constrained settings such as Bangladesh.

CASE PRESENTATION: A 40-year-old female of Asian origin, Class I obese (BMI 32 kg/m2), presented to the emergency department with acute severe dyspnea, pleuritic chest pain, and palpitations. Her medical history was notable for obesity and hypertension, which had been managed with antihypertensive medication for the past 3 years. Additionally, she had been taking a LD-OCP for 4 months for menstrual irregularity. Despite initial management with low-molecular-weight heparin and supportive measures, the patient's condition rapidly deteriorated to severe cardiogenic shock, necessitating urgent intervention. Thrombolytic therapy with alteplase was administered, which significantly improved the patient's hemodynamic status. Follow-up imaging revealed a reduction in the thrombus burden and resolution of deep vein thrombosis.

CLINICAL DISCUSSION: This case highlights the critical role of early diagnosis and prompt thrombolytic therapy, such as alteplase, in managing acute PE. Rapid intervention can prevent severe complications. Clinicians must maintain high suspicion in symptomatic patients, especially women on hormonal therapy, and use timely diagnostics like D-dimer and CT angiography.

CONCLUSION

In resource-limited settings, the timely administration of thrombolytic agents such as alteplase can significantly improve patient outcomes, as demonstrated in this case.