Thrombolytic therapy for prosthetic cardiac valve thrombosis.

To determine the efficacy and safety of thrombolytic therapy for prosthetic valve thrombosis, a composite series of 41 patients who received either streptokinase or urokinase intravenously for this disorder were analyzed. The series comprised 3 patients treated at Rhode Island Hospital and 38 previously reported on. Short-term success was achieved in 32 patients (78%). Prosthetic valve thrombosis recurred in seven (22%) of the successfully treated patients, four of whom were retreated with thrombolytic therapy. A favorable clinical outcome was observed in each. Fever and venipuncture bleeding were the most frequent side effects. Systemic embolization occurred in 4 (15%) of 26 patients with either aortic or mitral prosthetic valve thrombosis. None of these latter patients experienced a permanent neurologic or circulatory deficit. It is concluded that thrombolytic therapy is of value in the treatment of prosthetic valve thrombosis.

Isoniazid-induced fever.

A 56-year-old man was started on therapy with isoniazid after exhibiting a positive reaction to an intradermal injection of intermediate-strength purified protein derivative of tuberculin. After the first dose and each of the following three doses, nausea, vomiting, chills, and an elevated body temperature ranging from 38 degrees C (100.4 degrees F) to 40 degrees C (104. degrees F) occurred. There was no evidence of a hypersensitivity reaction to isoniazid, such as cutaneous rash, eosinophilia, elevated concentration of IgE, and abnormal results on tests of hepatic function. Following discontinuance of therapy with isoniazid, the temperature returned to normal. This experience illustrates the potential of isoniazid to cause febrile reactions, a situation that could be misdiagnosed as an infectious process.