Bengal Physician Journal

Register      Login

VOLUME 11 , ISSUE 1 ( January-April, 2024 ) > List of Articles


A Case of Vitamin B12 Deficiency and Hyperhomocysteinemia-induced Sub-massive Pulmonary Thromboembolism

Sounak K Roy, Pulakesh Sinha, Abhinay Tibdewal, Saubhik Kanjilal, Soumitra Kumar

Keywords : Anticoagulant, Case report, Hyperhomocysteinemia, Pulmonary embolism, Thrombosis, Vitamin B12

Citation Information : Roy SK, Sinha P, Tibdewal A, Kanjilal S, Kumar S. A Case of Vitamin B12 Deficiency and Hyperhomocysteinemia-induced Sub-massive Pulmonary Thromboembolism. Bengal Physician Journal 2024; 11 (1):38-41.

DOI: 10.5005/jp-journals-10070-8037

License: CC BY-NC 4.0

Published Online: 18-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


The relation between pulmonary embolism and hypercoagulable state has been a debate in medical literature. There have been articles describing role of hyperhomocysteinemia in vascular injuries leading to prothrombotic state. We herein present a case of unprovoked sub-massive pulmonary thromboembolism secondary to hyperhomocysteinemia due to hypovitaminosis B12. The patient was investigated thoroughly and was managed with proper anticoagulants.

PDF Share
  1. Mantoo S, Qadri SM, Mehfooz N, et al. Prevalence and predictors of pulmonary embolism in patients with acute exacerbation of chronic obstructive pulmonary disease. Lung India 2021;38(6):533–539. DOI: 10.4103/lungindia.lungindia_79_21.
  2. Hirmerová J. Homocysteine and venous thromboembolism—Is there any link?. Cor et Vasa 2013;55(3): e248–e258. DOI: 10.1016/j.crvasa.2013.01.007.
  3. Reznik EV, Shcherbakova ES, Borisovskaya SV, et al. ST-elevation myocardial infarction, pulmonary embolism, and cerebral ischemic stroke in a patient with critically low levels of natural anticoagulants. J Cardiol Cases 2019;21(3):106–109. DOI: 10.1016/j.jccase.2019.11.003.
  4. Kovalenko O, Kassem AN, Jenkins M. Hyperhomocysteinemia and pulmonary embolism in a young male. Cureus 2020;12(4):e7818. DOI: 10.7759/cureus.7818.
  5. Khaliq L, Kabir KF, Pyai K, et al. A simple vitamin deficiency with life-threatening complications: A case of B12 deficiency and hyperhomocysteinemia-induced thrombosis. Cureus 2023;15(8):e42908. DOI: 10.7759/cureus.42908.
  6. Biron F, Rousseau JF, Baulin JM, et al. Événement thromboembolique et hyperhomocystéinémie métabolique: Case-report et revue de la littérature [Thromboembolic event and metabolic hyperhomocysteinemia: A case report and review of literature]. Ann Cardiol Angeiol (Paris) 2021;70(3):177–182. DOI: 10.1016/j.ancard.2021.01.008.
  7. Ogawa S, Katayama T, Kaikita K, et al. Chronic thromboembolic pulmonary hypertension complicated with homocystinuria. Intern Med 2014;53(22):2605–2608. DOI: 10.2169/internalmedicine.53.2206.
  8. Undas A, Brożek J, Szczeklik A. Homocysteine and thrombosis: from basic science to clinical evidence. Thrombosis Haemostasis 2005;94(11):907–915. DOI: 10.1160/TH05-05-0313.
  9. Cellai AP, Lami D, Antonucci E, et al. Hyperhomocysteinemia in patients with pulmonary embolism is associated with impaired plasma fibrinolytic capacity. J Thromb Thrombolysis 2014;38(1):45–49. DOI: 10.1007/s11239-013-0981-1.
  10. Sadiq W, Subhan M. Isolated homocysteinemia leading to thromboembolism in young male with normal vitamin B12 and folate levels. Cureus 2017;9(12):e1978. DOI: 10.7759/cureus.1978.
  11. Shilova AN, Karpenko AA, Klevanets IuE. [Pulmonary artery thromboembolism on the background of hyperhomocysteinemia]. Angiol Sosud Khir 2015;21(1):25–28. Russian. PMID: 25757162.
  12. Oliveira LR, Fonseca JR. Simultaneous pulmonary thromboembolism and superior mesenteric venous thrombosis associated with hyperhomocysteinemia secondary to pernicious anemia-induced vitamin B12 deficiency. Hematol Transfus Cell Ther 2018;40(1):79–81. DOI: 10.1016/j.htct.2017.11.004.
  13. Oh JK, Park JH. Role of echocardiography in acute pulmonary embolism. Korean J Intern Med 2023;38(4):456–470. DOI: 10.3904/kjim.2022.273.
  14. Moore AJ, Wachsmann J, Chamarthy MR, et al. Imaging of acute pulmonary embolism: an update. Cardiovasc Diagn Ther 2018;8(3):225–243. DOI: 10.21037/cdt.2017.12.01.
  15. Westafer LM, Long B, Gottlieb M. Managing pulmonary embolism. Ann Emerg Med 2023;82(3):394–402. DOI: 10.1016/j.annemergmed.2023.01.019.
  16. Kaptein FH, Kroft LJ, Hammerschlag G, et al. Pulmonary infarction in acute pulmonary embolism. Thromb Res 2021;202:162–169. DOI: 10.1016/j.thromres.2021.03.022.
  17. Warren DJ, Matthews S. Pulmonary embolism: investigation of the clinically assessed intermediate risk subgroup. Br J Radiol 2012;85(1009):37–43. DOI: 10.1259/bjr/17451818.
  18. Konstantinides SV, Barco S, Lankeit M, et al. Management of pulmonary embolism: an update. J Am Coll Cardiol 2016;67(8):976–990. DOI: 10.1016/j.jacc.2015.11.061.
  19. Raja AS, Greenberg JO, Qaseem A, et al. Clinical Guidelines Committee of the American College of Physicians*. Evaluation of patients with suspected acute pulmonary embolism: best practice advice from the Clinical Guidelines Committee of the American College of Physicians. Ann Intern Med 2015;163(9):701–711. DOI: 10.7326/M14-1772.
  20. Konstantinides SV, Meyer G, Becattini C, et al. The task force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC) 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019;54(3):1901647.
  21. Kahn SR, de Wit K. Pulmonary Embolism. N Engl J Med 2022;387(1): 45–57. DOI: 10.1056/NEJMcp2116489.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.