Urticarial allergic reaction to alteplase: A case report (P6.243)

OBJECTIVE: To describe an atypical allergic reaction to alteplase in a patient with acute ischemic stroke. BACKGROUND: Allergic reactions to thrombolytic agents can be expected but are most commonly seen with streptokinase administration, probably because alteplase is structurally identical to endogenous tPA and therefore should not induce allergy. Hypersensitivity to alteplase has been estimated to occur in less than 0.02[percnt] of patients who receive it for the treatment of acute myocardial infarction, but in patients treated for acute ischemic stroke it might be more common. DESIGN/METHODS: We review possible hypersensitivity reactions to alteplase and describe an atypical allergic reaction to it. RESULTS: 58 year old male with a previous history of treatment of panniculitis with ciprofloxacin 500mg/day and metronidazole 800mg/day, was admitted with sudden onset of right central facial palsy, right hemiplegia and aphasia. Brain CT had an Aspects 7 and we started thrombolytic therapy. During rtPA infusion he showed confluent, blistering and pruritic injuries at the site of infusion, rapidly progressing to trunk, abdomen, back and testicular region. He became hypotensive, reversed with 1.5L 0.9[percnt] saline. We started antihistamin and intravenous hydrocortisone with improvement of the lesions for 4 hours when the lesions emerged again. Corticosteroids were maintained for 2 days and removed due to the absence of new lesions after 24 hours of Actilyse® infusion. He presented mild fever during the hospitalization with whole blood count showing mild leukocytosis and an elevated total IgE levels. C3 levels were normal. He received ceftriaxone for 14 days for bacteremia showing no further signs of hypersensitivity to any other medications administered. He was discharged after investigation with diagnosis of cryptogenic stroke and urticarial allergic reaction to Actilyse®. CONCLUSIONS: Physicians treating acute ischemic stroke with alteplase should be aware of this uncommon but potentially dangerous complication in the spectrum of anaphylactic reactions. Disclosure: Dr. Papolin has nothing to disclose. Dr. Mendes has nothing to disclose. Dr. Lange has nothing to disclose. Dr. Germiniani has nothing to disclose. Dr. Harger has nothing to disclose. Dr. Zetola has nothing to disclose. Dr. Chamma has nothing to disclose.