A Heavy Price for Lightness: Pulmonary Embolism Following Tirzepatide Initiation

Background/Objective Pulmonary embolism (PE) is a multifactorial thromboembolic disorder, with obesity and inherited thrombophilia among its recognized risk factors. Tirzepatide, a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, is increasingly used for weight management, but its relationship with thromboembolic events is unclear. The objective of this report is to describe a patient with PE occurring shortly after initiation of tirzepatide, highlighting a distinctive clinical scenario in a patient with underlying predisposing factors. Case Report A 35-year-old woman with a body mass index of 42 kg/m 2 presented with 1 day of right-sided pleuritic chest pain and dyspnea. She denied fever, hemoptysis, palpitations, calf swelling, recent travel, surgery, trauma, or oral contraceptive use. Three weeks earlier, she had started tirzepatide 2.5 mg weekly for weight management. Examination revealed tachycardia at 103 beats per minute, with otherwise unremarkable cardiopulmonary findings. Laboratory evaluation showed a D-dimer level of 607 ng/mL (reference