Pulmonary Embolism in a Healthy Woman using oral contraceptive containing ethinyl estradiol: A Case Report
Abstract:
Background: Combined oral contraceptive (COC) use has been associated with venous thromboembolism (VTE) (i.e., deep venous thrombosis and pulmonary embolism). The risk for VTE has been evaluated for many estrogen doses and progestogen types contained in COC with an increased risk of VTE for females taking third generation COCs (containing desogestrel, drospirenone, or gestodene) than the use of second-generation COCs (containing levonorgestrel).
Case Description: We present a case of an obese (BMI 34.33 kg/m2) nulligravid 20-year-old female with no significant past medical history who developed a pulmonary embolism one year after using third generation COCs (Lo Loestrin and Estarylla) without any additional risk factors for thrombosis. The patient presented with palpitations for a day along with chest pain, shortness of breath, vomiting, and diarrhea. Two weeks prior to the onset of palpitations, she reported having a pain in her left lower extremity. Lower extremities vein doppler revealed no evidence of deep vein thrombosis in both lower extremities. Chest computed tomography angiography (CTA) showed extensive bilateral pulmonary emboli (PE) including a large embolus at the right pulmonary artery and bilateral patchy irregular ground glass opacities. Transthoracic Echocardiography showed a positive McConnell’s sign of the right ventricular free wall akinesis with sparing of the apex. The patient was started on full anticoagulation with a heparin drip for 48 hours, with uncomplicated hospital course. Long term oral anticoagulants were prescribed.
Conclusion: All oral contraceptives are associated with some risk of venous thromboembolism, which should be taken into consideration when these drugs are prescribed. The effect size depended both on the progestogen used and the dose of ethinyl estradiol. Presenting symptoms vary amongst individuals, thus proper diagnostic workup is necessary. Anticoagulation is the mainstay of PE treatment both in the in‐hospital treatment phase and after hospital discharge and should be initiated as soon as the diagnosis of PE is suspected.
