title: [Paradoxic occurrence of symptoms of rheumatic fever after thrombolytic therapy with streptokinase--a case of delayed hypersensitivity?].
abstract: We report the case of a 51-year-old patient with a Paget von Schrötter-Syndrome of the right arm who underwent a successful lysis therapy with 9 x 10(6) IU streptokinase (Streptase) i.v. over 3 days. 36 h after ending the lysis therapy he developed a generalized eczema, which was interpreted as a drug-induced allergic reaction of the arthus type (Coombs III). He received methylprednisolone p.o. with an initial dose of 40 mg, tapered to 0 over 5 days. One day after the efflorent rash the patient developed fever for 12 h (with 38.8 degrees C maximum) and a gonarthritis of the left knee, and 24 h later of both knees. An echocardiogram showed a small pericardial effusion without hemodynamic influence. On the following 2 days a minimal proteinuria of 0.28 and 0.22 g/l was found. Subsequently and after a follow-up of 2 years, the patient was totally free of pathologic clinical and laboratory findings. We interpret this unusual case as a delayed hypersensitivity reaction to streptokinase with a paradoxical occurrence of clinical symptoms formally fulfilling the diagnostic criteria of "rheumatic fever".
authors.affiliation: Abteilung Hämatologie, Onkologie, Immunologie, Philipps-Universität, Marburg.
authors.forename: G
authors.initials: G
authors.lastname: Kolb
authors.forename: R
authors.initials: R
authors.lastname: Funck
authors.forename: B
authors.initials: B
authors.lastname: Maisch
authors.forename: K
authors.initials: K
authors.lastname: Havemann
mesh_terms: D016918:Arthritis, Reactive / Q000209:etiology; D001367:Axillary Vein / Q000187:drug effects; D003937:Diagnosis, Differential; D003875:Drug Eruptions / Q000209:etiology*; D004342:Drug Hypersensitivity / Q000209:etiology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000139:chemically induced; D012213:Rheumatic Fever / Q000139:chemically induced*; D013300:Streptokinase / Q000009:adverse effects* / Q000627:therapeutic use; D013350:Subclavian Vein / Q000187:drug effects; D013577:Syndrome; D015912:Thrombolytic Therapy; D013927:Thrombosis / Q000188:drug therapy*
chemical_list: D013300:Streptokinase
vernacular_title: Paradoxes Auftreten von Symptomen des rheumatischen Fiebers nach einer Lysetherapie mit Streptokinase--eine allergische Spätreaktion?