Conclusion and results

Supportive care involved continuous monitoring of thrombolysis related complications and symptomatic treatment for heart failure, including potential diuretics and oxygen therapy. For serum sickness as a complication of streptokinase therapy, pain management and steroid were considered which resolved spontaneously after 3 days of symptoms. The symptoms of serum sickness had resided so further, complement testing which include C3 and C4 for diagnosis was not sent. Echocardiography was done which suggested a high-pressure gradient prosthetic mitral valve of 11 mm Hg and diagnosis of a stuck mitral valve was made for which streptokinase thrombolysis was started. Though streptokinase was started again, the patient had developed a headache for which Neurology consultation was done, however haven’t developed joint pain, fever and rashes. Post surgery echocardiography suggested a normal prosthetic valve with 4.4 mm hg mean gradient across the valve and normal left ventricular systolic function. The patient was ambulatory, tolerating oral feeds and stable. The patient was discharged after 18 days of hospital stay and given Oral Furosemide 40 mg BD, Oral Warfarin 9 mg OD, Oral Metoprolol 37.5 mg OD and Oral Aspirin 75 mg OD. On regular follow up, the patient was normal, and her shortness of breath has also resolved. Following streptokinase, she hasn’t developed symptoms consistent with serum sickness like the previous one.