Case Report: Phloroglucinol-Induced Kounis Syndrome

Abstract

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.

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

“…Kounis syndrome is an acute coronary syndrome of allergic reaction-mediated coronary artery spasm with or without erosion or rupture of atherosclerotic plaques. Kounis syndrome should be suspected when patients present with symptoms such as chest pain and dyspnea and generalized allergic reactions (e.g., red rash and wheezing), even in the absence of a history of coronary heart disease ( 6 ). Allergic coronary artery spasm, allergic myocardial infarction, and in-stent thrombosis are the three types of this syndrome.…”

“…Antihistamines have the side effect of hypotension, which is not suitable for patients with anaphylactic shock ( 19 ). Vasodilators, such as nitrate and calcium channel blockers, can relieve allergic vasospasm but may induce and worsen hypotension ( 6 ). Therefore, clinicians have to be careful to select appropriate and safe treatment options.…”

Plaque rupture and neovascularisation detected with optical coherence tomography in a case of Kounis syndrome

“…In patients with atheromatous disease, one type II variant is caused by spasm or plaque erosion/rupture. The vast majority of reported cases of type II Kounis syndrome due to plaque rupture have been angiographically diagnosed with intracoronary imaging being extremely rare 2 3. Because angiography can only detect plaque rupture in cases with typical findings, such as ulcerated plaque, many patients with coronary spasms may have been misdiagnosed.…”

“…It is divided into three types: type I is caused by spasm in a normal coronary artery; type II results from spasm or plaque erosion/rupture in an atheromatous lesion; type III is due to stent thrombosis 1. The vast majority of reported cases of type II Kounis syndrome due to plaque rupture have been diagnosed angiographically with intracoronary imaging modalities, such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT), being extremely rare 2 3. We present a case of type II Kounis syndrome in which OCT detected angiographically undetectable plaque rupture.…”

Ibuprofen‐induced Kounis syndrome type 1—A rare case from India

“…1 The exact etiology of KS remains unclear. Recently, type 1 KS has been reported secondary to phloroglucinol 8 and inactivated SARS-CoV-2 vaccine. 9…”