MASSIVE HEMOPTYSIS AND HEMOTHORAX AFTER INTRA-PLEURAL FIBRINOLYTIC THERAPY

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Intrapleural fibrinolytic therapy is a common, surgery-avoiding option in treatment complicated para-pneumonic effusion. It has been shown to be safe majority patients, with most significant risk being severe pleural hemorrhage. In this case report, we will present unique patient who developed concurrent massive hemoptysis and hemothorax after infusion intrapleural tissue plasminogen activator (tPA) human recombinant deoxyribonuclease (DNase). CASE PRESENTATION: A 73-year-old male presented hospital right-sided chest pain shortness breath. He was found have necrotizing pneumonia his right lung, loculated Initially, involved intravenous antibiotics drainage 14 F pigtail tube. then received standard six doses tPA/DNase good initial response. However, over next few days there fluid re-accumulation which lead administration seventh dose tPA/DNase. Shortly afterwards, suffered hemorrhage requiring transfusion vasopressors. Subsequent thoracoscopy flexible bronchoscopy performed two later showed no active bleeding or endobronchial lesions. The survived discharged home weeks later. DISCUSSION: MIST2 trial demonstrated efficacy [1], however complications associated are still accumulating literature. Bleeding, serious complication therapy, more commonly occurs space. Research suggests may due molecular weight tPA prohibiting its diffusion across membrane, leading lingering effects space [2]. our patient, he also represents rare regimen. that properties created fistula, healed new necrotic lung tissue, exposed pre-existing communication within collection. There reported such bronchopleural migration but without observed sequelae [3]. manner, movement blood from into airways, hemoptysis. CONCLUSIONS: an effective for effusion, clinicians must cognizant risks benefits use. Our not only reports on one use, highlights need further discussion surrounding contraindications use as hemoptysis, though rare, can pretty life threatening. REFERENCE #1: Rahman NM, Maskell NA, West A, et al. DNase infection. N Engl J Med. 2011;365(6):518-526. doi:10.1056/NEJMoa1012740 #2: Piccolo F, Popowicz N, Wong D, Lee YC. Thorac Dis. 2015;7(6):999-1008. doi:10.3978/j.issn.2072-1439.2015.01.30 #3: Roy B, Teh MC, Kuok YJ, YCG. Bronchopleural following empyema. Respirol Rep. 2020;8(7):e00646. Published 2020 Aug 31. doi:10.1002/rcr2.646 DISCLOSURES: disclosure file Antonius Anis; No relevant relationships by Debby Chung, source=Web Response Sponsor relationship PulmonX Please note: 2016 Added 04/30/2021 David Hsia, Response, value=Grant/Research Nuvaira Support Gala Therapeutics 2021 Speaker/Speaker's Bureau Medtronic value=Honoraria Sharareh Shahangian,