Diffuse Alveolar Hemorrhage After Streptokinase Thrombolysis in ST-Segment Elevation Myocardial Infarction: A 2-Patient Case Series.

Diffuse alveolar hemorrhage is a rare and serious complication of thrombolytic therapy. We describe 2 patients with ST-segment elevation myocardial infarction who received streptokinase, developed diffuse alveolar hemorrhage, and survived. The first patient was a 46-year-old man with an inferior infarction. He later needed bypass grafting for triple-vessel disease. After receiving streptokinase, he experienced hemoptysis, decreasing hemoglobin, and bilateral ground-glass opacities on computed tomography. The second patient was a 52-year-old woman with anterior infarction. She experienced cardiac arrest during thrombolysis and underwent rescue angioplasty for failed thrombolysis. While on strong dual antiplatelet therapy for her stent, she developed a similar pulmonary syndrome, which was identified as blood-tinged endotracheal secretions during ventilation. Both patients received corticosteroids, temporary changes in their antithrombotic therapy, and supportive care. They achieved full recovery while their coronary disease was treated further. These cases highlight the careful diagnosis and treatment needed when hemorrhagic and ischemic processes occur together.