Case History/ Examination
A 36-year-old female, with a known history of mitral valve stenosis
secondary to rheumatic heart disease, underwent thrombolysis with
streptokinase three months ago and presented with the primary complaints
of shortness of breath on exertion for four days, orthopnea and
paroxysmal nocturnal dyspnea (PND). She had a significant past medical
history of mitral valve stenosis for which mitral valvotomy, double
valve repair and redo mitral valve repair was done. Patients had
recurring symptoms for which thrombolysis by streptokinase started 2
weeks ago. Following streptokinase treatment, the patient now presents
with shortness of breath, fever, and bilateral knee pain for the past
three days, with no history of photosensitivity, skin rashes, myalgia,
malaise and lymphadenopathy. (Figure 1) Her bowel and bladder habits
were normal.
On examination, the patient was afebrile, pulse was 70/minute regular,
respiratory rate was 20/minute, blood pressure was 100/70 mmHg. General
examination revealed no pallor, icterus, cyanosis, edema and increased
jugular venous pressure. Dermatological, cardiovascular and respiratory
system examination was done and found to be normal. On the joint
examination, there was no swelling, redness, or warmth on the knee
joint.