An illness resembling serum sickness and presenting with pyrexia, peripheral oedema, arthritis/arthralgia, and rash can complicate treatment with streptokinase.
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Br Heart J 1990;64:289-90
CASE REPORT
Rash after treatment with anistreplase Nigel Burrows, Robin Russell Jones were well controlled by treatment with Abstract A palpable purpura developed on the metformin (1 g twice a day), atenolol (100 mg legs and lower abdomen of a woman of once a day), and aspirin (100 mg daily). There 54 five days after she was treated with had been no recent change to her medication. anistreplase anisoylated plasminogen An electrocardiogram at presentation conactivator complex firmed an acute myocardial infarction with streptokinase in- considerable ST elevation in the inferior an acute myocardial for (APSAC) farction. Histological examination of leads. She was treated with 30 units of a skin biopsy specimen taken 6 days anistreplase, without heparin, by slow after treatment showed leucocytoclastic intravenous injection. She made an uneventful recovery until 5 vasculitis. The rash resolved within two weeks and there were no other days after anistreplase treatment when a palpable, purpuric rash developed mainly on complications. the extensor aspect of her legs and extended to the lower trunk. Plasma urea, serum creatinine, a full blood count, and clotting An illness resembling serum sickness and studies were normal. Urine microscopy was presenting with pyrexia, peripheral oedema, negative. Tests for antinuclear factor, arthritis/arthralgia, and rash can complicate antibody to extractable nuclear antigen, treatment with streptokinase."3 We report the rheumatoid factor, Australia antigen, and development of a rash as the sole complication cryoglobulins were also negative. A biopsy of treatment with anistreplase (anisoylated specimen of lesional skin (figure), obtained plasminogen streptokinase activator complex on day six, showed a mixed perivascular inflammatory cell infiltrate, red cell extra(APSAC)). vasation, fibrinoid necrosis of the dermal blood vessels, and fragmentation of neutrophils (leucocytoclasia). Staining by direct Case report A 54 year old Asian woman presented with a 6 immunofluorescence showed C3 and IgM hour history of central chest pain radiating around the blood vessels. These findings were down the left arm. She had non-insulin consistent with an acute leucocytoclastic dependent diabetes and hypertension that vasculitis.
