title: Diffuse alveolar hemorrhages and hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction.
abstract: Thrombolytic therapy with streptokinase is commonly used in acute myocardial infarction and has markedly reduced morbidity and mortality from this condition. However, it can cause various hemorrhagic and immunological complications. We report a patient who developed diffuse pulmonary hemorrhages and bilateral hemorrhagic pleural effusion after thrombolytic therapy with streptokinase for acute myocardial infarction. This was recognized by a drop of hematocrit, pulmonary infiltrates, hemorrhagic pleural effusion and hypoxemia. The diagnosis was confirmed by demonstration of iron-laden macrophages (siderophages) in bronchoalveolar lavage. The patient required mechanical ventilation and recovered successfully. This combination of pulmonary hemorrhages and hemorrhagic pleural effusion following streptokinase therapy is extremely unusual and has not been reported previously.
authors.affiliation: Department of Internal Medicine, King Abdul-Aziz Hospital and Oncology Center, PO Box 31467, Jeddah 21497, Kingdom of Saudi Arabia. drayyub@hotmail.com
authors.forename: Muhammad
authors.initials: M
authors.lastname: Ayyub
authors.forename: Shahid
authors.initials: S
authors.lastname: Barlas
authors.forename: Mohammad
authors.initials: M
authors.lastname: Iqbal
authors.forename: Samira M
authors.initials: SM
authors.lastname: Khurshid
mesh_terms: D000328:Adult; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008297:Male; D010996:Pleural Effusion / Q000209:etiology*; D011650:Pulmonary Alveoli; D013300:Streptokinase / Q000009:adverse effects* / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects*
chemical_list: D005343:Fibrinolytic Agents; D013300:Streptokinase