Abstract

Intrapleural streptokinase therapy (IST) is commonly used to manage pediatric parapneumonic effusion. Although considered safe, rare complications, such as pulmonary hemorrhage, have been reported, particularly in high-dose IST administration in patients with coexisting coagulopathy or trauma. We report a case of massive pulmonary hemorrhage following IST in a 14-month-old child with left parapneumonic effusion. He initially presented to the hospital with community-acquired pneumonia, and intravenous antibiotic therapy was initiated. Subsequently, he developed left complex parapneumonic effusion, with worsening respiratory distress requiring non-invasive ventilation. Chest tubes were inserted using the blind method and were complicated by traumatic insertion. Four hours after IST, the patient developed severe respiratory distress with profuse bleeding from the oronasal cavity. He required intubation and was ventilated for four days. There was no coagulopathy. Respiratory support was gradually weaned off, and the patient was discharged well after a six-week course of antibiotics. Healthcare providers should be vigilant regarding the risk of pulmonary hemorrhage, particularly in high-risk patients. Ultrasound-guided chest tube insertion, patient assessment before IST, and close monitoring during and after therapy may help minimize this adverse event. Further research is warranted to better understand the safety profile of IST in children.