Unsuspected vasculitis and intracranial hemorrhage following thrombolysis

Treatment with thrombolytic agents such as streptokinase or tissue plasminogen activator (TPA) is an accepted standard for the treatment of patients with acute myocardial infarction (MI). A devastating sequel of thrombolytic therapy may be the development of a hemorrhagic complication, particularly intracranial bleeding, which, although rare, is usually associated with significant neurologic sequelae or death. While various risk factors have been correlated with the development of intracranial hemorrhage following thrombolysis, a possible relationship between bleeding and a clinically unsuspected underlying vasculitis has not been previously reported. This report deals with the case of a 49-year-old man who died of multiple intracranial hemorrhages after thrombolytic therapy for acute MI and who was found at autopsy to have had polyarteritis nodosa of the coronary arteries and vasculitis of the meningeal vessels.