BackgroundKounis syndrome is a hypersensitive coronary artery disease caused by the body's exposure to allergens, which is induced by various drugs and environmental factors. This entity has been described primarily in isolated case reports and case series. We report a case of type III Kounis syndrome caused by cefoperazone-sulbactam.Case presentationA 79-year-old man who received an infusion of cefoperazone-sulbactam in Respiratory Department of our hospital for recurrent infections. 28 minutes later, he developed skin flushing of the trunk and extremities, soon followed by loss of consciousness and shock. With antianaphylaxis, pressor therapy, and fluid rehydration, the patient was admitted to the ICU for treatment. During which, he experienced recurrent ventricular fibrillation and a progressive increase in troponin I levels. The ECG of the patient showed that the ST segment elevation of lead II, III, avF, and V3R–V5R was 0.10–0.20 MV. An urgent coronary angiography showed an in-stent thrombosis in the middle part of the right coronary artery, occlusion of the distal flow with TIMI grade 0. The diagnosis was type III Kounis syndrome with cardiogenic shock. Despite aggressive treatment, the patient died on day 7 after ICU admission.ConclusionKunis syndrome is a life-threatening disease, and therefore allergic reactions in patients with a history of cephalosporin allergy and coronary stent implantation should be considered and treated promptly.

Rationale: The morbidity and mortality of lung cancer rank the first among all kinds of cancer. In China, anaplastic lymphoma kinase-positive pulmonary tumors account for nearly 5% of non-small cell lung cancer (NSCLC), and these patients are quite likely to develop brain metastases, as high as around 45%. Although anaplastic lymphoma kinase-tyrosine kinase inhibitors crizotinib and alectinib have proved effective for controlling tumor metastases to the brain, drug resistance and disease progression cannot be ignored in the course of treatment. Patient concerns: Most of the literature reports that traditional Chinese medicine (TCM) has produced satisfactory results in the treatment of cancer patients as an adjuvant treatment for various malignancies in a 53-year-old male patient who developed advanced NSCLC with brain metastases. As first-line crizotinib and erlotinib treatments were ineffective and the intracranial lesions progressed extensively, the patient chose to receive TCM treatment alone in the hope of prolonging his life and improving his quality of life. Diagnoses: A 53-year-old male patient who developed advanced NSCLC with brain metastasis. Because first-line crizotinib and alectinib have failed, and the intracranial lesions progressed in a large area. Interventions: The patient requested that the final therapeutic strategy be Chinese medicine as monotherapy for long-term treatment. The patient took 30 mL of the decoction 1 hour after a meal, 3 times a day. The patient was not treated with dehydrating agents or diuretics during the TCM treatment. Outcomes: The improvement was obvious after 3 months of treatment, and significant reduction of cranial lesions. During the follow-up period, the patient developed neither severe liver damage nor kidney damage. Lessons: This case is the first 1 in the world where TCM was introduced as monotherapy for severe conditions with extensive brain metastases and achieved remarkable efficacy.

Background: Aspergillus fumigatus is a filamentous fungus widely distributed in the environment and can cause life-threatening diseases in individuals with compromised immune barriers. To our knowledge, it has never been reported as a cause of intracranial infection in patients with heat stroke. We report a case of heat stroke patient with multifocal brain abscess caused by aspergillus fumigatus infection. Case presentation: A 48-year-old male patient was admitted to the intensive care unit due to fever and loss of consciousness. The patient was diagnosed with heat stroke because he worked in a high-temperature environment, had a hospital temperature of 42℃, had liver, kidney and heart damage, and had disseminated intravascular coagulation. Although the patient was actively rescued, the patient was still coma and fever. Head Computed tomography (CT) and magnetic resonance imaging ( MRI ) showed abnormal signal lesions in bilateral basal ganglia, right temporal lobe, left frontal lobe and left cerebellar hemisphere. Serum galactomannan increased. It was identified as Aspergillus fumigatus by next generation sequencing ( NGS ) using cerebrospinal fluid. The patient received 4 weeks of voriconazole treatment. Reexamination of head CT suggested that the range of low-density lesions in the above brain regions was reduced. Then the patient gradually woke up, could follow the instructions of exercise, and finally discharged. Conclusion: Heat stroke combined with multifocal brain abscess caused by aspergillus fumigatus infection is extremely rare. For patients who still have central nervous system symptoms and signs after conventional treatment, the possibility of intracranial infection needs to be considered.