Zavras-Kounis Type I Syndrome, Anaphylaxis, Wavy Double, and Wavy Triple Signs Post-Ceftriaxone-Responsive to Standard Anti-anaphylaxis

Abstract

Rationale: Drug-inducing side effects are undoubtedly one of the most frequent entities in applied medicine. Drug-inducing allergic angina, allergic coronary spasm, and allergic infarction are different recognized as Zavras-Kounis syndrome. The Kounis–Zavras syndrome and allergic angina are designated as the simultaneous existence of angina and allergic reactions associated with clinical and laboratory signs of classical angina pectoris. Both the Wavy triple electrocardiographic sign (Yasser’s Sign) and the related Wavy double sign (Yasser’s Sign) are innovative diagnostic signs in hypocalcemia. A Wavy double electrocardiographic sign was prescribed in hypocalcemia which is mostly seen with either tachycardia or bradycardia. Ceftriaxone is a third-generation cephalosporin prescribed for several bacterial infections. World Health Organization considered it in the List of Essential Medicines. Patient concerns: A 22-year-old married, security man, smoker, Egyptian male patient was admitted to the critical care unit with anaphylaxis and angina after an intravenous injection of ceftriaxone. Diagnosis: Zavras-Kounis syndrome type I, anaphylaxis, Wavy double, and Wavy triple signs post-ceftriaxone injection. Interventions: Electrocardiography, oxygenation, and echocardiography. Outcomes: The dramatic disappearance of anaphylactic shock, Zavras-Kounis syndrome type I, and coronary spasm after the traditional treatment of anaphylaxis had happened. Complete clinical and electrocardiographic recovery had been achieved. Lessons: Ceftriaxone injection can induce anaphylactic shock, Kounis–Zavras type I syndrome, coronary spasm, and anaphylaxis. Kounis–Zavras type I syndrome, coronary spasm, and anaphylaxis can be reversed with treatment of the cause without using anti-ischemic or ant-arrhythmic measures. The identification of drug-induced disease is a pivotal step in the diagnosis and decision-making of any medical problems. Reassurance was recommended regarding ceftriaxone-induced coronary spasm accompanied by anaphylaxis.