Is Clomiphene the Culprit?

Pulmonary embolism is a well known culprit in the medical world with a mortality as high as 30% for untreated population [1]. Multiple risk factors have been described including, but not limited to immobility, trauma, oral contraceptive use, drugs, and malignancy. One of the most common risk factors widely recognized is oral contraceptive use in females. However, there are only limited case reports of pulmonary embolism associated with hormone use therapy in males [2-4]. Here, we describe a case of a middle aged male with hypogonadism treated with clomiphene that developed pulmonary embolism. After recognizing Clomiphene as a plausible cause, the drug was discontinued, and the patient was treated with intravenous heparin while in the hospital and subsequently discharged on a direct oral anticoagulant. His workup was negative for malignancy, thrombophilia, and infection. He did not have other known risk factors for pulmonary embolism including trauma, recent surgery, or immobilization. Pulmonary embolism (PE) is a common occurrence resulting in significant morbidity and mortality. Clinical pictures of pulmonary embolism can vary ranging from asymptomatic incidental findings to sudden cardiac death [5]. Pulmonary embolism can be categorized as provoked or unprovoked. Common causes of provoked pulmonary embolism are recent trauma, surgery, immobilization, longair travel, autoimmune disease, and inherited thrombophilia [6]. Medications such as hormonal contraceptives, other hormonal therapy, and glucocorticoids can increase the risk for pulmonary embolism. While less common, there are a few cases reported for Clomiphene citrate associated with pulmonary embolism. Clomiphene citrate has also been associated with other thromboembolic complications like central retinal vein occlusion and intracranial venous thrombosis [7,8].