Kolb G, Funck R, Maisch B, Havemann K
Abteilung Hämatologie, Onkologie, Immunologie, Philipps-Universität, Marburg.
Z Rheumatol. 1994 Jan-Feb;53(1):7-10.
We report the case of a 51-year-old patient with a Paget von Schrötter-Syndrome of the right arm who underwent a successful lysis therapy with 9 x 10(6) IU streptokinase (Streptase) i.v. over 3 days. 36 h after ending the lysis therapy he developed a generalized eczema, which was interpreted as a drug-induced allergic reaction of the arthus type (Coombs III). He received methylprednisolone p.o. with an initial dose of 40 mg, tapered to 0 over 5 days. One day after the efflorent rash the patient developed fever for 12 h (with 38.8 degrees C maximum) and a gonarthritis of the left knee, and 24 h later of both knees. An echocardiogram showed a small pericardial effusion without hemodynamic influence. On the following 2 days a minimal proteinuria of 0.28 and 0.22 g/l was found. Subsequently and after a follow-up of 2 years, the patient was totally free of pathologic clinical and laboratory findings. We interpret this unusual case as a delayed hypersensitivity reaction to streptokinase with a paradoxical occurrence of clinical symptoms formally fulfilling the diagnostic criteria of "rheumatic fever".
我们报告了一例51岁右臂患有帕热特·冯·施勒特综合征的患者，该患者接受了为期3天的静脉注射9×10(6)国际单位链激酶（链道酶）的成功溶栓治疗。溶栓治疗结束36小时后，他出现了全身性湿疹，被解释为阿瑟斯型（库姆斯III型）药物诱导的过敏反应。他口服甲泼尼龙，初始剂量为40毫克，在5天内逐渐减至0。皮疹出现一天后，患者发热12小时（最高体温38.8摄氏度），左膝关节出现膝关节炎，24小时后双膝均出现膝关节炎。超声心动图显示有少量心包积液，但无血流动力学影响。在接下来的2天里，发现微量蛋白尿，分别为0.28克/升和0.22克/升。随后，经过2年的随访，患者的临床和实验室检查均未发现异常。我们将这一罕见病例解释为对链激酶的迟发性超敏反应，同时出现了符合“风湿热”诊断标准的矛盾性临床症状。
