Intra-pleural tissue plasminogen activator and deoxyribonuclease: An alternative treatment option for pleural infections in specific populations

Pleural infections can be associated with significant morbidity and mortality. Systemicantibiotics and drainage are the standard treatment, but some patients require surgicalintervention for complete resolution. For unsuitable surgical candidates, the intra-pleuraladministration of tissue plasminogen activator and deoxyribonuclease (tPA/DNase) is apotential treatment option for loculated effusions. We present a case of loculated empyemasuccessfully treated with a 3-day course of once daily intra-pleural administration of tPA/DNase. Considering the frailty of our patient, we choose the once daily tPA/DNase due toconcerns about potential complications, such as increased risk of bleeding. The published trialevidence and administration regimens of intra-pleural tPA/DNase are also discussed.