BMJ Case Reports 2017; doi:10.1136/bcr-2017-221239
  • Novel treatment (new drug/intervention; established drug/procedure in new situation)

Low-dose intrapleural alteplase (without deoxyribonuclease) in complicated parapneumonic effusion: case series and literature reviews

  1. Mohamed Faisal Abdul Hamid1,3
  1. 1Department of Medical, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  2. 2Department of Internal Medicine, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
  3. 3Department of Medical, Pusat Perubatan Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia
  1. Correspondence to Nurashikin Mohammad, elshikina{at}
  • Accepted 29 August 2017
  • Published 11 September 2017


This case series reviews two cases of elderly patients who presented with fever, cough and shortness of breath. Clinical examinations and initial chest radiographs confirmed unilateral pleural effusion. Thoracenteses were consistent with exudative pleural effusion. We commenced intravenous antibiotics treating for parapneumonic effusions. The first case showed persistent effusion despite drainage, and the second case had a little aspirate from pleural tapping. Subsequent ultrasound of the thorax showed multiloculated effusions. We made the decisions for intrapleural fibrinolytic therapy using low-dose alteplase 2.5 mg each time, in view of the elderly patient as sacrosanct for risk of bleeding. Furthermore, DNase was not used, as it is not yet available in our setting. Both of our patients had good clinical and radiological outcomes, without the need for surgical interventions.


  • Handling editor Seema Biswas.

  • Contributors CL, NM and MFAH were involved in the conception of the case report, review of literature and writing the manuscript. TMH revised this critically and contributed to important intellectual content. All authors participated in the final revision of the manuscript and approved the final manuscript and are also accountable for the accuracy of the content.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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