Hemothorax With White-Out Lung After Intrapleural Tissue Plasminogen Activator and Deoxyribonuclease Therapy in a Patient With Complicated Parapneumonic Effusion

Abstract

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.

Streptococcus pyogenes Pneumonia: A Rare and Severe Presentation in a Patient With Asthma

“…In June 2022, Mainali et al reported a case of a 57-year-old female with a large right exudative effusion complicated with parapneumonic effusion treated with t-PA and DNAse therapy leading to the formation of hemothorax on the first treatment with t-PA [16]. On the other hand, our patient showed a positive response to treatment to t-PA and DNAse.…”

“…Urinalysis was positive for protein (>500), esterase (trace), WBC (10)(11)(12)(13)(14)(15)(16)(17)(18)(19), WBC clumps, and red blood cells (30-49). Urine Legionella and Streptococcus pneumoniae antigens were negative.…”