title: Unintentional intramuscular administration of tPA/DNase for pleural infection.
abstract: Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown. We report a patient treated in another center who was unintentionally administered up to six instillations of tPA (10 mg) and DNase (5 mg) intramuscularly via a malpositioned chest drain. The patient experienced minimal discomfort, and there were no signs of tissue inflammation or necrosis on computed tomography. No complications were detected over a 2-month follow-up. Upon transfer, a new pleural drain was inserted and tPA/DNase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.
authors.affiliation: Pharmacy Department, Sir Charles Gairdner Hospital Perth, Australia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Popowicz
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Nash
authors.affiliation: Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Australia ; Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia Perth, Australia.
authors.forename: Y C Gary
authors.initials: YC
authors.lastname: Lee
keywords: Deoxyribonuclease; empyema; intramuscular; pleural infection; tissue plasminogen activator