Case report: Cefoperazone-sulbactam induced Kounis syndrome and cardiogenic shock

Abstract

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.

Case Report: Kounis syndrome due to cryptopteran bite

“…Systolic compression of the muscle bridge can lead to mast cell aggregation and cause coronary spasm. This theory is also consistent with the coronary angiography results of this case ( 8 , 9 ).…”

Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review

“…There are no reported deaths in the literature due to Kounis syndrome in the pediatric population. Sixteen out of the 330 case reports that we investigated of adult patients reported death due to Kounis syndrome or its complications [27,[93][94][95][96][97][98][99][100][101][102].…”

Adrenaline, Takotsubo, Anaphylaxis, and Kounis Syndrome (ATAK) Complex Unveiled: Integrating Takotsubo and Kounis Syndromes in the Context of Chemotherapy-Related Anaphylaxis

“…Kounis syndrome is a subtype of coronary artery disease triggered by the body's reaction to allergens. It arises from a confluence of medications and environmental elements [ 1 ]. It is characterized as the simultaneous occurrence of acute coronary syndrome (ACS) and heightened sensitivity reactions resulting from an allergic episode [ 2 ].…”