Type I Kounis Syndrome after Protracted Anaphylaxis and Myocardial Bridge-Brief Literature Review and Case Report.

Liviu Ghilencea,Mihaela Roxana Popescu,Cristina Conea,Andreea Catarina Popescu,Ileana Maria Ghiordanescu,Mihai Melnic

doi:10.3390/diagnostics10020059

Liviu Ghilencea, Mihaela Roxana Popescu + Show 4 more

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https://doi.org/10.3390/diagnostics10020059

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Abstract

The term allergic angina, introduced for the first time by Nicholas Kounis in 1991, initially referred to the coexistence of acute coronary syndromes with allergy or hypersensitivity. At present, it is believed that Kounis syndrome is a particular case of systemic disease, with multiorgan arterial involvement generated during immediate hypersensitivity reactions. Myocardial bridging (MB), a condition that can induce coronary artery spasm, has long been regarded as a benign condition. Since both pathologies are associated with arterial spasm, Kounis syndrome and MB are considered to be confounding pathologies for acute coronary syndromes, and their association is quite a rare finding. To date, there are no precise data on the epidemiology, and the population affected by Kounis syndrome seems to be highly heterogeneous. Since this is a rare disease, even less is known about possible different phenotypes, including MB overlap. We report a case of type I variant Kounis syndrome associated with MB with no evidence of coronary artery disease, occurring as late presentation, following a severe systemic reaction (anaphylaxis) induced by a Hymenoptera sting. At present, only two other cases of type I and one case of type II Kounis syndrome occurring in patients with myocardial bridging have been described.

Highlights

Necrotizing arteritis and periarteritis of the coronary arteries in humans associated with serum disease after exposure to pneumococcal and tetanus antitoxin were first described in 1938, and several similarities with anaphylactic reactions induced in animals by foreign serums have been observed [1]
In was not until 1950 that the first case of an acute coronary syndrome associated with an allergic reaction due to penicillin was reported [2]
In 1991, Nicholas Kounis described the relationship between allergies and acute coronary syndromes [3] and used the terms “allergic angina” and “allergic infarction” to define the syndrome

Summary

Introduction

Necrotizing arteritis and periarteritis of the coronary arteries in humans associated with serum disease after exposure to pneumococcal and tetanus antitoxin were first described in 1938, and several similarities with anaphylactic reactions induced in animals by foreign serums have been observed [1]. Arachidonic acid products (AAP), atherosclerotic (ATS), cytokines paradoxical effect in the myocardial tissue (favorizes thrombus formation) Both the local and (CK), growth factors (GFs), hypersensitivity reaction (HSR) [12], platelet-activating factor (PAF). The most frequent triggers for Kounis syndrome are drugs (metamizole [13], beta-lactam venoms and snake venoms (Hymenoptera, cobra [22,23,24,25]), certain foods (tuna fish [26]), and proteins antibiotics: ampicillin-sulbactam [13,14,15], penicillin [2], cefuroxime [16,17,18], and other antibiotics, present in the natural latex [11].

Discussion

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