A 25 year old male presented with a flu like syndrome rapidly progressing to acute respiratory distress syndrome and ultimately resulting in death. On autopsy examination, death was due to pulmonary emboli ( PE) originating from thrombosis of the periprostatic venous plexus. This is the first reported case of PE in a young patient as a result of thrombosis from the prostatic venous plexus. This case substantiates and emphasizes the importance of identifying PE in a timely fashion.
The patient was a 25 year old male who presented to the emergency room with complaints of difficulty in breathing, fever, chills and a cough. His initial chest x-ray revealed a right lower lobe infiltrate. Following a diagnosis of pneumonia, the patient was discharged home on erythromycin.Two days later, he was admitted to the hospital with symptoms of persistent shortness of breath. A repeat chest X-ray showed bilateral infiltrates. Treatment with antibiotics was continued for a possible diagnosis of atypical pneumonia.Initial arterial blood gases showed a pH 7.51, pCO2 31 mm Hg, pO2 51 mm Hg, HCO3 24.6 and Oxygen saturation of 85 %.Cultures for bacteria, acid fast organisms, fungi and viruses were collected. His HIV antibody titer was negative, WBC was 8.7 K/ UL, LDH 428 IU/ L. Repeated attempts failed to demonstrate an infectious etiology. The patient was treated presumptively for pneumocystis carinii pneumonia with Trimethoprim/ Sulfamethoxazole and continued on erythromycin. He developed progressive hypoxia with respiratory failure resulting in endotracheal intubation and mechanical ventilation. Despite aggressive respiratory treatment he continued to deteriorate and expired ten days later.An autopsy was performed which demonstrated bilateral massive pulmonary emboli with extensive infarctions. The source of the clots was found to be massive thrombosis of the periprostatic venous plexus. The prostate gland itself was unremarkable.DISCUSSION: PE commonly originates from thrombi located in the deep veins of the lower extremities. This represents the first report of multiple emboli secondary to massive thrombosis of the periprostatic plexus in a previously healthy 25 year old male. Common testing for deep venous thrombosis would not have detected the originating thrombi. This may explain why there is no English language medical literature describing periprostatic vein thrombi with a normal prostate gland and no history of examination or trauma to the prostate. Based on the age and previous good health of this young man pulmonary thromboembolic disease was not suspected.
This report emphasizes that PE should be considered in a young patient with progressive hypoxia and respiratory failure without a known infectious etiology.
P.V. Reddy, None.