Allergic acute coronary syndrome (Kounis syndrome) and sudden cardiac arrest due to cefoperazone-sulbactam in a patient with acute pancreatitis

Abstract

Introduction: Type 1 Kounis syndrome is an acute coronary syndrome characterized by coronary spasm due to an allergic insult. Patient concerns: A 74-year-old man exhibited ventricular fibrillation soon after cefoperazone-sulbactam treatment for acute pancreatitis. Diagnosis: The 12-lead electrocardiogram revealed ST segment elevation in the inferior leads after shock therapy with a defibrillator. An anaphylactic skin rash appeared over the entire body, and acute increase in serum tryptase was observed. Coronary angiography showed significant stenosis in the right coronary artery. Immediately after the cardiac arrest, serum tryptase was elevated to 53.4 pg/mL. Interventions: Intracoronary nitroglycerin, with support from temporary pacing, fluid therapy, hydrocortisone, and a vasopressor, successfully relieved the coronary stenosis and stabilized the hemodynamics. Outcomes: The patient recovered from acute pancreatitis without complications and was discharged uneventfully 11 days after the coronary angiography. Serum tryptase reverted to a normal level after 10 days. Conclusion: When changes in vital signs occur after drug administration, physicians should consider Kounis syndrome as a differential diagnosis, and manage appropriately according to the patient's hemodynamic status.