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Respirol Case Rep. 2014 Dec;2(4):144-6. doi: 10.1002/rcr2.80. Epub 2014 Oct 10.

Unintentional intramuscular administration of tPA/DNase for pleural infection.

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Pharmacy Department, Sir Charles Gairdner Hospital Perth, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Australia.
Department of Respiratory Medicine, Sir Charles Gairdner Hospital Perth, Australia ; Centre for Asthma, Allergy and Respiratory Research, School of Medicine and Pharmacology, University of Western Australia Perth, Australia.


Intrapleural tissue plasminogen activator (tPA) and deoxyribonuclease (DNase) therapy has recently been shown to improve outcomes in pleural infection in a randomized trial. Published literature, to date, consists of only ∼50 patients who had received tPA/DNase. Safety data of this regimen remain limited. Pleural contents often track along chest drains, but the effect of tPA/DNase on subcutaneous tissues is unknown. We report a patient treated in another center who was unintentionally administered up to six instillations of tPA (10 mg) and DNase (5 mg) intramuscularly via a malpositioned chest drain. The patient experienced minimal discomfort, and there were no signs of tissue inflammation or necrosis on computed tomography. No complications were detected over a 2-month follow-up. Upon transfer, a new pleural drain was inserted and tPA/DNase administered with clearance of his loculated complicated parapneumonic effusion. This case adds to the safety profile of intrapleural tPA/DNase therapy and highlights the importance of correct tube placement.


Deoxyribonuclease; empyema; intramuscular; pleural infection; tissue plasminogen activator

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