Anaphylactic reaction to streptokinase with first exposure: case report and review of the literature

Adverse reaction to streptokinase with multiple systemic manifestations

We report the case of a 47-year-old woman with a history of mitral valve replacement with a mechanical prosthesis who was admitted to the hospital with a 3-month history of progressive exertional dyspnoea and was diagnosed as suffering from prosthetic valve thrombosis. Two consecutive courses of streptokinase were given as an intravenous infusion over 90 min at a dose of 1,500,000 IU each. Twenty minutes after the start of the second infusion (3 h and 20 min after the first one) she developed chills, fever, tachycardia and hypotension: symptomatic treatment was given and the infusion was completed. Two days later jaundice and choluria appeared with laboratory findings of hepatic cytolysis and cholestasis and renal insufficiency. The results of extensive microbiological and immunological investigations were not revealing. All the laboratory values spontaneously returned to baseline levels over the next 4 weeks. These abnormalities were attributed to an allergic reaction to streptokinase, although the exact pathogenic mechanisms involved are not known. We believe that further studies to elucidate the mechanism involved in the production of these effects are warranted in view of their potential clinical severity.

Microembolism from aortic aneurysm and ventricular thrombus: a complication of intravenous streptokinase

Two patients sustained the rare complication of skin infarction following administration of intravenous streptokinase for acute myocardial infarction. We report evidence that dissolution of thrombus from an unsuspected source and subsequent microembolization of the skin may be responsible for this complication. In patients known to have an aortic aneurysm or ventricular thrombus, careful consideration should be given to the use of intravenous streptokinase following myocardial infarction.

Life-threatening, localized angio-oedema associated with streptokinase

We report what we believe to be the first documented case of localized angio-oedema of the upper airway secondary to streptokinase.

Streptokinase morbidity--more common than previously recognised

Streptokinase is the thrombolytic agent most commonly used for the treatment of acute myocardial infarction. We report eight patients who developed late uncommon adverse reactions to streptokinase probably due to immune complex disease. The clinical manifestations included vasculitic rashes, abnormal renal and liver function tests and a syndrome resembling adult respiratory distress syndrome. Major adverse events with streptokinase such as stroke, bleeding and other allergic reactions, have been previously documented but the morbidity related to delayed reactions has not been widely recognised. These reactions produced significant morbidity resulting in prolonged hospital stay and may need to be considered in the decision to use streptokinase.