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, how ever, benefits are maximal when patients at higher risk for complicati ons can be identified and treatment decisions modified to reduce the c hance of adverse events. Streptokinase, a commonly used and inexpensiv e thrombolytic, is known to cause both bleeding and immunologic compli cations, and coexistent conditions predisposing to either are consider ed relative or absolute contraindications to its use. We report an unu sual case of immune-mediated diffuse pulmonary hemorrhage following st reptokinase administration for acute myocardial infarction in a patien t with pulmonary infection and concurrent cutaneous infection. We prop ose that these infections constitute additional risk factors and may b e used to identify patients at higher risk of this complication from s treptokinase.