Early stent thrombosis in Kounis syndrome - a case report

Abstract

Introduction. Kounis syndrome is a simultaneous manifestation of acute coronary syndrome with conditions associated with mast cell activation, such as allergies or anaphylactic reactions. We present early stent thrombosis in female with atopic constitution without previous aterosclerosis of coronary arteries. Case report. A 50-year-old female with typical anginal pain was addmited to Clinic for Cardiology, UCC Nis. She had passed by a linden tree in bloom, few hrs before, and immediately after felt chest pain, paresthesia and numbnes in her left hand, throat tightness, heaviness of the tongue, and swelling of the lips. Symptoms stopped for 60 min after taking 10 mg of loratadine. 30 min after addmision ECG showed ST elevation in D2, D3, aVF, V6. She underwent an emergency percutaneous coronary intervention (PCI) procedure. Occlusive thrombosis was seen in the ostium of the left anterior descending (LAD) coronary artery. Sirolimus-coated stent was placed with Thrombolysis in Myocardial Infarction (TIMI) 3 flow obtained. A few hrs later, patient reported a new onset of chest pain followed by ventrucular fibrilation (VF), DC shock and occurence of new ST segment elevation in aVR, V1-V3. Repeated angiography showed acute in-stent trombotic occlusion. Baloon angioplasty was performed which restored TIMI 3 flow in LAD. Anticoagulant and corticosteroid therapy was administered. Three days following an intervention, optical coherence tomography (OCT) imiging showed no signs of aterosclerosis and restenosis, adequate stent expansion and apposition. Conclusion. Coronary agiography proved type I Kounis syndrome after the exposure to an allergen, and type III Kounis syndrome developed shortly after stent placement. Newly described causes of acute and subacute stent thrombosis in type III Kounis syndrome are stent-associated hypersensitivity reactions.