Kounis Syndrome Secondary to Medicine-Induced Hypersensitivity

Introduction Kounis syndrome is the concurrence of an acute coronary syndrome (ACS) caused by coronary vasospasms, acute myocardial infarctions, or stent thromboses in case of allergic or hypersensitivity reactions. Kounis syndrome is mediated by mast cells that interact with macrophages and T-lymphocytes, causing degranulation and inflammation with cytokine release. It is a life-threatening condition that has many trigger factors and is most commonly caused by medicines. Case Presentation. A 71-year-old male was admitted with a fever of five days' duration associated with cellulitis, for which he had been treated with clindamycin and flucloxacillin before admission. He was a diagnosed patient with hypertension and dyslipidemia five years ago. After taking the antibiotics, he had developed generalized itching followed by urticaria suggesting an allergic reaction. Therefore, he was admitted to the hospital. After admission, he developed an ischaemic-type chest pain associated with autonomic symptoms and shortness of breath. An immediate ECG was taken that showed ST-segment depressions in the chest leads V4–V6, confirmed by a repeat ECG. Troponin I was 8 ng/mL. Acute management of ACS was started, and prednisolone 10 mg daily dose was given. After complete recovery, the patient was discharged with aspirin, clopidogrel, atorvastatin, metoprolol, losartan, isosorbide mononitrate, and nicorandil. Prednisolone 10 mg daily dose was given for five days after discharge. Conclusion In immediate hypersensitivity, with persistent cardiovascular instability, Kounis syndrome should be considered, and an electrocardiogram and other appropriate assessments and treatments should be initiated. Prompt management of the allergic reaction and the ACS is vital for a better outcome of Kounis syndrome.

[1]  N. Kounis,et al.  Reply to the letter: "Kounis syndrome: Towards a new classification". , 2021, International journal of cardiology.

[2]  I. Koniari,et al.  COVID-19 and Kounis Syndrome: Deciphering Their Relationship , 2021, Balkan medical journal.

[3]  B. Özlek,et al.  Reply to the letter: "Kounis syndrome: Towards a new classification". , 2021, International journal of cardiology.

[4]  A. Gunapala,et al.  Cardiogenic Shock due to Kounis Syndrome following Cobra Bite , 2019, Case reports in critical care.

[5]  G. Tzanis,et al.  Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease , 2019, Balkan medical journal.

[6]  M. Labrador-Horrillo,et al.  Kounis Syndrome , 2019, Current Treatment Options in Allergy.

[7]  I. Diemberger,et al.  Drug-induced Kounis syndrome: A matter of pharmacovigilance. , 2019, International Journal of Cardiology.

[8]  S. Kakkos,et al.  Anaphylactic cardiovascular collapse and Kounis syndrome: systemic vasodilation or coronary vasoconstriction? , 2018, Annals of translational medicine.

[9]  H. Herath,et al.  Myocardial infarction during anaphylaxis in a young healthy male with normal coronary arteries- is epinephrine the culprit? , 2017, BMC Cardiovascular Disorders.

[10]  B. Limpo,et al.  Kounis syndrome: is it rare or is it underdiagnosed? , 2017, Kardiologia polska.

[11]  R. Subedi,et al.  Kounis syndrome: A review article on epidemiology, diagnostic findings, management and complications of allergic acute coronary syndrome. , 2017, International journal of cardiology.

[12]  P. Edirisinghe,et al.  Death following ceftazidime-induced Kounis syndrome , 2017, The Medico-legal journal.

[13]  Bruno Limpo,et al.  Zespół Kounis: rzadki czy niedostatecznie często rozpoznany? , 2017 .

[14]  N. Kounis.  Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management , 2016, Clinical chemistry and laboratory medicine.

[15]  E. Heffler,et al.  Kounis syndrome: A concise review with focus on management. , 2016, European journal of internal medicine.

[16]  O. H. Kim,et al.  Evaluation of myocardial injury through serum troponin I and echocardiography in anaphylaxis. , 2016, The American journal of emergency medicine.

[17]  E. Buchanan.  Kounis syndrome. , 2016, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[18]  S. Kularatne,et al.  Kounis syndrome secondary to amoxicillin/clavulanic acid administration: a case report and review of literature , 2015, BMC Research Notes.

[19]  N. Amarasena,et al.  Myocardial infarction associated with eosinophilia and plasma extravasation at multiple sites. A variant of Kounis syndrome , 2015, BMJ Case Reports.

[20]  S. Kularatne,et al.  A case of Kounis syndrome after a hornet sting and literature review , 2014, BMC Research Notes.

[21]  N. Papadopoulos,et al.  First European data from the network of severe allergic reactions (NORA) , 2014, Allergy.

[22]  N. Kounis,et al.  The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes , 2014, Journal of natural science, biology, and medicine.

[23]  F. Granata,et al.  Human heart as a shock organ in anaphylaxis , 2014, Allergo Journal International.

[24]  N. Kounis.  Coronary hypersensitivity disorder: the Kounis syndrome. , 2013, Clinical therapeutics.

[25]  F. Almerigogna,et al.  Kounis syndrome (allergic acute coronary syndrome): different views in allergologic and cardiologic literature , 2012, Internal and Emergency Medicine.