Mainali Arjun, Adhikari Samaj, Chowdhury Tutul, Gousy Nicole, Bisural Roshan, Devkota Saujan, Kaphle Bastola Ambika Devi
Internal Medicine, Interfaith Medical Center, Brooklyn, USA.
Medicine, American University of Antigua, New York, USA.
Cureus. 2022 Jun 22;14(6):e26208. doi: 10.7759/cureus.26208. eCollection 2022 Jun.
Tissue plasminogen activator (tPA) and recombinant deoxyribonuclease (DNase ) are used in treating pleural infection due to their mucolytic activity by effectively reducing pleural fluid viscosity. The combination of tPA and DNase has attracted considerable interest as an alternative to surgical intervention for treating complicated parapneumonic effusion in high-risk patients who are not good candidates for surgery. However, intrapleural hemorrhage has been reported as a villainous outcome in a few cases which needs to be considered as a differential diagnosis with sudden clinical deterioration after the therapy. Here, we report the case of a patient who presented with pneumonia and later developed a large right complicated parapneumonic pleural effusion. A chest tube was placed with drainage of fluid while tPA and DNase were also considered as an additional treatment module. Following the first dose of DNase and tPA, the patient developed hypoxemia with hypotension and was found to have rapid development of white-out right hemothorax.
组织型纤溶酶原激活剂（tPA）和重组脱氧核糖核酸酶（DNase）因其具有黏液溶解活性，可有效降低胸腔积液的黏稠度，故而用于治疗胸膜感染。tPA与DNase联合使用，作为手术干预的替代方案，用于治疗手术风险高、不适合手术的复杂类肺炎性胸腔积液患者，已引起广泛关注。然而，有报道称，少数病例出现了胸膜内出血这一严重后果，治疗后临床突然恶化时，需将其视为鉴别诊断。在此，我们报告一例患者，该患者最初患肺炎，随后发展为右侧大量复杂类肺炎性胸腔积液。放置胸腔引流管引流积液，同时将tPA和DNase作为附加治疗方案。首次使用DNase和tPA后，患者出现低氧血症和低血压，右侧胸腔迅速出现白肺样血胸。
