Abstract
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.
Highlights
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
Allergic angina syndrome and allergic myocardial infarction are ubiquitous diseases that affect patients of any age. ey cover a broad spectrum of mast cell-activation disorders that are referred to as Kounis syndrome. e definition of this syndrome is the concurrence of an acute coronary syndrome (ACS) in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults. ese cases of ACS may occur due to coronary spasms, acute myocardial infarctions, or stent thromboses [2]. e primary inflammatory cells involved in the development of Kounis syndrome are mast cells that interact with macrophages and T-lymphocytes
Kounis syndrome was defined in 1991 as “the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of classic angina pectoris caused by inflammatory mediators released during the allergic insult” [6]
Summary
Cardiovascular manifestations associated with allergy, hypersensitivity, and anaphylactic or anaphylactoid reactions began to emerge seven decades ago in the medical literature. The clinical condition of allergic angina syndrome, which progresses to allergic acute myocardial infarction, was not described until 1991 [1]. E primary inflammatory cells involved in the development of Kounis syndrome are mast cells that interact with macrophages and T-lymphocytes. Allergic angina syndrome and allergic myocardial infarction are ubiquitous diseases that affect patients of any age. Kounis syndrome is a complex situation involving two severe circumstances, an acute allergic reaction and an acute coronary event. We report a case of Kounis syndrome possibly triggered by antibiotics administered due to cellulitis of the right lower limb. He was followed up at the cardiac rehabilitation clinic. A coronary angiogram was planned, the patient defaulted follow-up
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
