Abstract
Kounis syndrome (KS) is defined as an allergic or hypersensitivity reaction leading to coronary vasospasm and acute coronary syndrome. The inflammatory mediators released during the body’s reaction to an allergen causes vasoconstriction, plaque rupture, platelet aggregation, and even thrombosis of an existing coronary stent. Over the years, many allergens including drugs, environmental exposures, and animal and insect bites have been implicated in KS. Patients may present with elevated cardiac enzymes and electrocardiographic changes. We describe a case of a patient with no prior cardiac history who presented to the emergency department seeking treatment after multiple bee stings. The patient had non-specific electrocardiogram (ECG) changes and elevated cardiac enzymes consistent with a non-ST-elevation myocardial infarction. The patient underwent a pharmacologic stress test and myocardial perfusion imaging, which showed a perfusion defect consistent with ischemia. Selective right and left coronary angiography revealed a critical lesion at the proximal left circumflex artery. This was managed with percutaneous coronary intervention utilizing a bare-metal stent.
Highlights
Kounis syndrome (KS) describes the association of acute coronary syndrome (ACS) with concurrent anaphylactic or hypersensitivity disorder
We describe a case of a patient with no prior cardiac history who presented to the emergency department seeking treatment after multiple bee stings
Type 1 KS is seen in patients with coronary artery vasospasm caused by the underlying anaphylactic reaction but no prior history of atherosclerotic coronary artery disease (CAD)
Summary
Kounis syndrome (KS) describes the association of acute coronary syndrome (ACS) with concurrent anaphylactic or hypersensitivity disorder. Pertinent labs included complete blood count, with a white cell count of 17,260/uL, hemoglobin of 18.3 g/dL, and platelet count of 319,000/uL His initial basic metabolic panel showed acute kidney injury with creatinine of 2.78 mg/dL and GFR (glomerular filtration rate) of 23. The ECG revealed a normal sinus rhythm at a rate of 70 bpm, left axis deviation, right bundle branch block, and left anterior fascicular block with a QRS duration of 130 ms; no significant ST-T wave segment changes were identified (Figure 1). He received intravenous (IV) fluids, IV methylprednisolone, and IV diphenhydramine in the ED.
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