Drug Points

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# Drug Points {#article-title-2} Skin necrosis induced by streptokinase Drs J Penswick and A L Wright (Bradford Royal Infirmary, Bradford BD9 6RJ) write: We describe a case of skin necrosis induced by treatment with streptokinase. There have been several previous reports of similar cases associated with heparin and warfarin; more recently there has been a report of a purpuric eruption in three patients who received streptokinase.1 To our knowledge, there are no similar reports of such extensive skin necrosis. A 70 year old man with a history of angina, hypertension, and peripheral vascular disease was admitted with chest pain. Changes in his electrocardigram suggested an inferior myocardial infarction, and he received 1.5 million units intravenous streptokinase. Twenty four hours later he complained of diffuse tenderness across the upper thighs. Nursing staff noticed areas of bruising on his lower trunk. Over the next 72 hours these areas spread to the upper parts of his buttocks and thighs. He remained haemodynamically stable, his haemoglobin concentration not changing and platelet concentrations and results of a clotting screen remaining normal. After four days no further bruising had developed and he was discharged. Nine days later large areas of ulceration had developed in the distribution of the original bruises (figure). All haematological investigations including protein C and protein S concentrations were normal. A skin biopsy specimen …

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