Acute ST Elevation Myocardial Infarction Due to Allergic Reaction, Kounis Syndrome

Rajha, Eva; Didi, Ahmad; Dakik, Habib A.; Mufarrij, Afif

doi:10.1016/j.ajem.2019.10.006

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…Kounis syndrome is an acute coronary syndrome characterized by coronary artery spasm induced by allergic reactions, accompanied or not accompanied by erosion or rupture of atherosclerotic plaque. Patients who present with angina-equivalent symptoms (such as chest pain and dyspnea) and systemic allergic reaction (such as erythematous rash and wheezing) with or without a history of coronary heart disease should be suspected of Kounis syndrome ( 3 ). Clinical manifestations and medical history are the main diagnostic basis for Kounis syndrome.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Phloroglucinol-Induced Kounis Syndrome

Gao

Cao

et al. 2021

Front. Cardiovasc. Med.

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Background: Kounis syndrome is an allergy-related acute coronary syndrome that is induced by various pharmacological and environmental factors. Given that many clinicians are not aware of this condition, many cases may be underdiagnosed. We report a case of type II Kounis syndrome induced by phloroglucinol.Case Summary: A 52-year-old man with pre-existing coronary artery stenosis presented with a 30-min history of chest pain and erythematous rash after intramuscular administration of phloroglucinol. An electrocardiogram demonstrated ST-segment elevation in leads II, III and aVF. Emergency coronary angiography revealed severe stenosis in the distal right coronary artery. Intravascular ultrasound showed plaque rupture and thrombosis, and the minimum lumen area was 3.0 mm2. A 3.5 × 38 mm stent was implanted in the distal right coronary artery. Troponin I levels were elevated. A diagnosis of type II Kounis syndrome induced by phloroglucinol was made, and the condition manifested as acute ST-segment elevation myocardial infarction.Conclusions: Clinicians should be aware of Kounis syndrome as a possible diagnosis in a patient who presents with chest pain and allergic manifestations given that an increasing number of triggers are being reported.

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Section: Discussionmentioning

confidence: 99%

Case Report: Phloroglucinol-Induced Kounis Syndrome

Gao

Cao

et al. 2021

Front. Cardiovasc. Med.

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“…The venom of Vespidae has cytotoxic effects, and it may sustain a skin necrotic effect. The other effect is Kounis syndrome, which is defined by the occurrence of acute coronary syndrome (ACS) in the setting of an allergic, hypersensitivity, or anaphylactic condition [ 37 ]. Two patients in our study were admitted under these conditions, and another patient had suspected epinephrine-induced ACS.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

Lin

Chiu

Chang

et al. 2020

IJERPH

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Background: Hymenopteran stings are the most common animal insult injury encountered in the emergency department. With increasing global spread of imported fire ants in recent decades, the rate of Formicidae assault has become a serious problem in many countries. Formicidae-associated injuries gradually increased in Taiwan in recent decades and became the second most common arthropod assault injury in our ED. The present study aimed at comparing the clinical characteristics of Formicidae sting patients with those of the most serious and common group, Vespidae sting patients, in an emergency department (ED) in Taiwan. Methods: This retrospective study included patients who were admitted between 2015 to 2018 to the ED in a local teaching hospital in Taiwan after a Vespidae or Formicidae sting. Cases with anaphylactic reaction were further compared. Results: We reviewed the records of 881 subjects (503 males, 378 females; mean age, 49.09 ± 17.62 years) who visited our emergency department due to Vespidae or Formicidae stings. A total of 538 (61.1%) were categorized into the Vespidae group, and 343 (38.9%) were sorted into the Formicidae group. The Formicidae group had a longer ED length of stay (79.15 ± 92.30 vs. 108.00 ± 96.50 min, p < 0.01), but the Vespidae group had more cases that required hospitalization (1.9% vs. 0.3%, p = 0.04). Antihistamines (76.8% vs. 80.2%, p < 0.01) were more frequently used in the Formicidae group, while analgesics were more frequently used in the Vespidae group (38.1% vs. 12.5%, p < 0.01). The Vespidae group had more local reactions, and the Formicidae group had more extreme, systemic, or anaphylactic allergic reactions. Creatine kinase was significantly higher in the Vespidae group with an anaphylactic reaction. Sting frequency in both groups exhibited the same positive associations with average temperature of the month and weekend days. Conclusion: Formicidae sting patients presented to the ED with higher rate allergic reactions and spent more time in the ED than Vespidae sting patients. However, Vespidae sting patients had more complications and higher rates of admission, especially with anaphylactic reaction. Laboratory data, especially creatine kinase data, were more valuable to check in Vespidae sting patients with an anaphylactic reaction in the ED. Both groups exhibited positive correlations with temperature and a higher rate on weekend days.

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“…This syndrome is associated with serious morbidity and mortality, as it could be complicated by cardiac arrest or even death [6]. Although it is rarely reported, it is imperative to understand that Kounis syndrome is usually underdiagnosed [7].…”

Section: Introductionmentioning

confidence: 99%

Epirubicin-induced Kounis syndrome

Liang

Zhao

Gao

et al. 2021

BMC Cardiovasc Disord

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Background Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. Case presentation A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. Conclusions Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.

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Acute ST Elevation Myocardial Infarction Due to Allergic Reaction, Kounis Syndrome

Cited by 6 publications

References 13 publications

Case Report: Phloroglucinol-Induced Kounis Syndrome

Case Report: Phloroglucinol-Induced Kounis Syndrome

Comparison of Clinical Manifestations, Treatments, and Outcomes between Vespidae Sting and Formicidae Sting Patients in the Emergency Department in Taiwan

Epirubicin-induced Kounis syndrome

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