Two patients developed the cholesterol embolization syndrome after coronary angiography and intravenous streptokinase therapy for acute myocardial infarction. Clinical manifestations included cyanosis, ulcers, gangrene of the hands and feet, myalgias, intestinal infarction, eosinophilia, and renal failure. One patient died; one has survived with chronic renal failure. Streptokinase therapy may expose atheromatous plaques to the circulation by lysing platelet-fibrin thrombi.