Kounis Syndrome: A Case of Vancomycin-Associated Coronary Artery Vasospasm Resulting in Myocardial Infarction

The curious case of Kounis syndrome: Exploring clinical manifestations and management in the presence of nonobstructive coronary arteries

“…Despite differences in temporal onset, the symptoms experienced by our patient were similar to those described in a similar case report of a 57-year-old man with vancomycin-induced KS who also presented with chest pain, diaphoresis, and headache 11 . In contrast, a more severe presentation was observed in an 83-year-old female with vancomycin-induced KS who presented with unresponsiveness and signs of respiratory distress and hemodynamic instability shortly after vancomycin infusion 6 .…”

“…In both this case and a similar case described by Gagnon et al, symptoms did not develop until the third dose of IV vancomycin was administered 10 . This is in contrast to two other cases of vancomycin-induced KS in which symptoms developed within 5 min of receiving the initial dose, suggesting that clinical manifestations of KS are dosingdependent and may depend on individual differences in immune response or metabolic processing of the drug 6,11 .…”

“…Common allergic/anaphylactic symptoms such as urticaria, pruritus, angioedema, congestion, and wheezing were absent across all case reports of vancomycin-induced KS, including this present study 6,10,11 . This underscores the significance of recognizing that KS, despite its underlying etiology as a mast-cell-driven type I hypersensitivity reaction, can still be a diagnostic possibility, even in the absence of typical allergic symptoms.…”