Tissue plasminogen activator associated pulmonary hemorrhage in patient with ACTA2-associated arteriopathy

Pulmonary hemorrhage after administration of tissue plasminogen activator (tPA) is a rare complication. We present a 15-year-old boy with a heterozygous pathogenic variant in ACTA2 who presented with right brachial artery aneurysm thrombosis treated initially with tPA, resulting in pulmonary hemorrhage. We hypothesize that the underlying pulmonary abnormalities caused by the pathogenic ACTA2 variant may be a risk factor for pulmonary hemorrhage after tPA administration.