Correspondence
Bilateral Anterior Uveitis: A Feature of Streptokinase-Induced Serum Sickness
N Engl J Med 1994; 330:576-577February 24, 1994
- Article
To the Editor:
Streptokinase is a commonly used thrombolytic agent. An unusual but well-documented adverse reaction is serum sickness1. Serum sickness typically develops one to two weeks after exposure to an antigen, with manifestations ranging from asymptomatic cutaneous eruptions to severe conditions such as glomerulonephritis, vasculitis, or pericarditis. Other features include fever, arthralgias, albuminuria, lymphadenopathy, and dependent edema. The condition usually resolves after withdrawal of the causative agent, but systemic corticosteroid therapy may be indicated if end-organ damage is severe. We report a case of serum sickness in which uveitis was a presenting feature.
A 54-year-old man was admitted for acute myocardial infarction and was given intravenous streptokinase (1.5 million units over a period of 60 minutes). Seven days later, an asymptomatic maculopapular rash, fever, proteinuria, polyarthralgias, polymyalgias, and ocular irritation developed, with elevated serum creatinine concentrations. Ophthalmic examination revealed mild conjunctival injection and a moderate degree of anterior-chamber inflammation in both eyes.
A diagnosis of serum sickness associated with bilateral acute anterior uveitis was made. Both eyes were treated with prednisolone acetate drops. Because of persistent renal insufficiency, treatment with systemic corticosteroids was begun; the patient's renal function returned to normal and his systemic manifestations resolved. There was no recurrence after the steroids were discontinued.
Streptokinase-induced serum sickness is well known1. There is also an apparent relation between serum sickness and anterior uveitis, although few cases have been reported,2 possibly because the uveitis is often mild or asymptomatic. Previous case reports describe only vague symptoms even with considerable degrees of anterior-segment inflammation, similar to that in our patient3.
Siebert et al. found that up to 6 percent of patients treated with streptokinase had some degree of serum sickness4 but suggested that the condition may be underreported. Recognition of anterior uveitis may assist in the early diagnosis and treatment of serum sickness. Furthermore, anterior uveitis associated with serum sickness is easily treated, thus decreasing potential ocular morbidity.
4 ReferencesBrian D. Proctor, D.O.
Patrick G. Murray Eye Center, Highland Park, MI 48203Brian C. Joondeph, M.D.
St. John Hospital and Medical Center, Detroit, MI 482361
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CrossRef | Medline
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