Life-threatening, localized angio-oedema associated with streptokinase.

A 59 year old woman was admitted to hospital with severe chest pain subsequently confirmed to be due to myocardial infarction. She suffered from stable angina and maturity onset diabetes and had sustained an anterior myocardial infarction 2 years prior to the admission for which she was not given thrombolytic therapy. She had no history of a recent sore throat or allergies and was taking daily propanolol 60 mg, aspirin 150 mg, isosorbide mononitrate 30 mg, frusemide 40 mg and gliclazide 320 mg. Eight hours after the onset of her pain she was commenced on an intravenous infusion of 1.5 million units of streptokinase in 5% dextrose over one hour. Ten minutes later, after receiving approximately 0.2 million units, she complained of periorbital swelling. The infusion was stopped immediately, and she was given 100 mg hydrocortisone and 4 mg chlorpheniramine intravenously. She remained normotensive with a pulse rate of 60 beats/ minute and there was no rash or fever. An emergency clotting screen confirmed significant amounts of streptokinase had been received (prothrombin time 25, control 15 seconds; activated partial thromboplantin time 60, control 28 seconds; thrombin time> 200, control 14 seconds; fibrinogen