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.