Diffuse Pulmonary Hemorrhage after Streptokinase Administration for Acute Myocardial Infarction

Fibrinolytic drug therapy has markedly reduced morbidity and mortality from acute myocardial infarction. As with any other drug therapy, however, benefits are maximal when patients at higher risk for complications can be identified and treatment decisions modified to reduce the chance of adverse events. Streptokinase, a commonly used and inexpensive thrombolytic, is known to cause both bleeding and immunologic complications, and coexistent conditions predisposing to either are considered relative or absolute contraindications to its use. We report an unusual case of immune-mediated diffuse pulmonary hemorrhage following streptokinase administration for acute myocardial infarction in a patient with pulmonary infection and concurrent cutaneous infection. We propose that these infections constitute additional risk factors and may be used to identify patients at higher risk of this complication from streptokinase.