ADVERSE REACTION TO STREPTOKINASE WITH MULTIPLE SYSTEMIC MANIFESTATIONS

We report the case of a 47-year-old woman with a history of mitral val ve replacement with a mechanical prosthesis who was admitted to the ho spital with a 3-month history of progressive exertional dyspnoea and w as diagnosed as suffering from prosthetic valve thrombosis. Two consec utive courses of streptokinase were given as an intravenous infusion o ver 90 min at a dose of 1,500,000 IU each. Twenty minutes after the st art of the second infusion (3 h and 20 min after the first one) she de veloped chills, fever, tachycardia and hypotension; symptomatic treatm ent was given and the infusion was completed. Two days later jaundice and choluria appeared with laboratory findings of hepatic cytolysis an d cholestasis and renal insufficiency. The results of extensive microb iological 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 react ion to streptokinase, although the exact pathogenic mechanisms involve d are not known. We believe that further studies to elucidate the mech anisms involved in the production of these effects are warranted in vi ew of their potential clinical severity.