Thrombolytic therapy remains widely used in majority of developing countries, where delivery
of primary percutaneous coronary intervention (PCI) remains a challenge. Unfortunately,
complications following such therapy remains prominent, predominantly bleeding-related
problems. We present a rare case of massive renal subcapsular haemorrhage and hematoma
following thrombolytic therapy. A 61-year old gentleman presented following an episode of
chest pain due to acute ST-elevation myocardial infarction. Due to potential delays in obtaining
PCI, the patient was counselled for thrombolysis using streptokinase which he had consented
to. Unfortunately, within 36 hours of admission, he developed abdominal pain, haematuria,
hypotension and altered mental status, associated with acute drops in haemoglobin levels.
Following initial resuscitation efforts, a Computed Tomography scan of the abdomen was
performed revealing a massive renal subcapsular hematoma, likely secondary to previous
thrombolysis. Renal subcapsular hematoma can either be spontaneous or iatrogenic, the latter
often due to coexisting renal-based neoplasm or vasculitidies. Iatrogenic causes include
trauma, following renal biopsies or anticoagulation therapy amongst a few others. Iatrogenic
renal subcapsular haemorrhage and hematoma formation are rare following thrombolysis. Our
literature search revealed only one other similar case, although this was following
administration of recombinant Tissue Plasminogen Activator in a case of acute ischaemic
cerebrovascular accident. This case highlights the complexity in management, following the
findings in terms of need for cessation of dual antiplatelet therapy and timing for PCI and stent
selection.