{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T14:16:02Z","timestamp":1790777762121,"version":"4.1.0"},"reference-count":12,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,8,4]]},"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:p>Managing a complicated pleural infection related to postsurgery can pose a clinical challenge, especially when initial interventions such as intercostal chest drain and antibiotics prove ineffective. We describe a man in his mid-60s who developed a recurrence of exudative pleural effusion caused by an oesophageal leak following laparoscopic total gastrectomy with Roux-y oesophagojejunostomy for gastric adenocarcinoma. Surgical repairs and oesophageal stenting were performed to address the oesophageal leak. Despite attempts at intercostal chest tube drainage, ultrasonography-guided targeted drainage of the locule and antibiotics, he did not show any improvement. He was unfit for surgical decortication. Due to the risk of bleeding, we chose a modified dose of intrapleural alteplase 5\u2009mg and DNase 5\u2009mg at 12-hour intervals for a total of three doses. This led to the complete resolution of the effusion. This case highlights that intrapleural tPA\/DNase can be an adjunctive therapy in postsurgery-related complicated pleural effusion.<\/jats:p>","DOI":"10.1136\/bcr-2022-249927","type":"journal-article","created":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T11:03:42Z","timestamp":1692270222000},"page":"e249927","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Combined intrapleural alteplase and DNase therapy in complicated pleural infection arising from postsurgery oesophageal leak"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0750-3087","authenticated-orcid":false,"given":"Boon Hau","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-649X","authenticated-orcid":false,"given":"Nik Nuratiqah","family":"Nik Abeed","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3788-4789","authenticated-orcid":false,"given":"Andrea Yu-Lin","family":"Ban","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7526-361X","authenticated-orcid":false,"given":"Mohamed Faisal","family":"Abdul Hamid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,8,17]]},"reference":[{"key":"2025082804382338000_16.8.e249927.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1012740"},{"key":"2025082804382338000_16.8.e249927.2","article-title":"Low dose intrapleural alteplase and pulmozyme (Dnase) in two post-surgical patients with pleural sepsis","volume":"30","author":"Faisal","year":"2020","journal-title":"Respir Med Case Rep"},{"key":"2025082804382338000_16.8.e249927.3","doi-asserted-by":"crossref","DOI":"10.1002\/rcr2.457","article-title":"Very low-dose Intrapleural tPA for indwelling pleural catheter-associated symptomatic fluid loculation","volume":"7","author":"Lan","year":"2019","journal-title":"Respirol Case Rep"},{"key":"2025082804382338000_16.8.e249927.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042473"},{"key":"2025082804382338000_16.8.e249927.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2012.02.005"},{"key":"2025082804382338000_16.8.e249927.6","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1165\/rcmb.2014-0017OC","article-title":"Tissue plasminogen activator potently stimulates pleural effusion via a monocyte chemotactic protein-1-dependent mechanism","volume":"53","author":"Lansley","year":"2015","journal-title":"Am J Respir Cell Mol Biol"},{"key":"2025082804382338000_16.8.e249927.7","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2180-8-173","article-title":"Characterization of biofilm matrix, degradation by Dnase treatment and evidence of capsule downregulation in Streptococcus pneumoniae clinical isolates","volume":"8","author":"Hall-Stoodley","year":"2008","journal-title":"BMC Microbiol"},{"key":"2025082804382338000_16.8.e249927.8","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1016\/S2213-2600(20)30533-6","article-title":"Use of fibrinolytics and deoxyribonuclease in adult patients with pleural empyema: a consensus statement","volume":"9","author":"Chaddha","year":"2021","journal-title":"Lancet Respir Med"},{"key":"2025082804382338000_16.8.e249927.9","doi-asserted-by":"crossref","first-page":"1512","DOI":"10.1513\/AnnalsATS.201602-127OC","article-title":"Concurrent intrapleural instillation of tissue plasminogen activator and Dnase for pleural infection. 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