Non-ST segment elevation myocardial infarction after multiple bee stings. A case of “delayed” Kounis II syndrome?

Nittner-Marszalska, Marita; Kopeć, Agnieszka; Biegus, Marta; Kosińska, Magdalena; Obojski, Andrzej; Pawłowicz, Robert; Gillert-Smutnicka, Małgorzata; Panaszek, Bernard

doi:10.1016/j.ijcard.2013.01.062

Cited by 14 publications

(12 citation statements)

References 25 publications

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“…Stings and bites by these insects are common with a myriad of local and systemic reactions. 1,2 Of the various varieties of honey bees, the Africanized honey bee (Apismellifera scutellata) is the most common subspecies implicated. Though uncommon, the systemic manifestations include anaphylaxis, dyspnea, bronchospasm, generalized edema, vasculitis, acute renal failure, neuritis, encephalitis, and serum sickness.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, direct myocardial necrotizing effect of large amounts of venom released during multiple bee stings has also been postulated as a cause of myocardial damage. 2,4,5 Two variants of Kounis syndrome have been described. 4 Type I variant includes normal coronary arteries without predisposing factors for coronary artery disease and Type II variant includes patients with culprit but quiescent pre-existing …”

Section: S179mentioning

confidence: 99%

“…[6][7][8] The clinical presentation of an acute coronary syndrome may be quite varied, ranging from being completely silent, to a delayed presentation several hours after of the sting. 2,9,10 The key to early diagnosis and management lies in a high index of clinical suspicion of this rare occurrence. The delay in diagnosis of AMI in our case was due to lack of awareness.…”

Section: S179mentioning

confidence: 99%

“…1 Rarely, Acute coronary syndrome may occur after an insect sting and is known as Kounis syndrome. 2 We report and discuss a case of 46-year-old male patient who had a STelevation anterior wall myocardial infarction (MI) following multiple bee stings.…”

Section: Introductionmentioning

confidence: 99%

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Kounis syndrome: Acute myocardial injury caused by multiple bee stings

Bharadwaj¹,

Joshi

Banerji

et al. 2016

Medical Journal Armed Forces India

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Section: Discussionmentioning

confidence: 99%

Section: S179mentioning

confidence: 99%

Section: S179mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Kounis syndrome: Acute myocardial injury caused by multiple bee stings

Bharadwaj¹,

Joshi

Banerji

et al. 2016

Medical Journal Armed Forces India

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“…18 As a result, this case may have presented as a 'delayed Kounis syndrome', of which two cases have been described in the literature. 19,20 The cytokine profile of this case is complicated by cardiac arrest as well as the fact that the patient was cooled with therapeutic hypothermia and rewarmed, a phenomenon known to influence cytokine profiles. 21,22 Interleukin (IL)-6 levels have been demonstrated to be elevated in therapeutic hypothermia following cardiac arrest, explaining the elevated level of IL-6 in our case.…”

Section: Discussionmentioning

confidence: 99%

Capecitabine-induced ventricular fibrillation arrest: Possible Kounis syndrome

Kido

Adams

Morehead

et al. 2015

J Oncol Pharm Pract

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We report the case of capecitabine-induced ventricular fibrillation arrest, possibly secondary to type I Kounis syndrome. A 47-year-old man with a history of T3N1 moderately differentiated adenocarcinoma of the colon, status-post sigmoid resection, was started on adjuvant capecitabine approximately five months prior to presentation of cardiac arrest secondary to ventricular fibrillation. An electrocardiogram (EKG) revealed ST segment elevation on the lateral leads and the patient was taken emergently to the cardiac catheterization laboratory. The catheterization revealed no angiographically significant stenosis and coronary artery disease was ruled out. After ruling out other causes of cardiac arrest, the working diagnosis was capecitabine-induced ventricular fibrillation arrest. As such, an inflammatory work up was sent to evaluate for the possibility of a capecitabine hypersensitivity, or Kounis syndrome, and is the first documented report in the literature to do so when evaluating Kounis syndrome. Immunoglobulin E (IgE), tryptase, and C-reactive protein were normal but histamine, interleukin (IL)-6, and IL-10 were elevated. Histamine elevation supports the suspicion that our patient had type I Kounis syndrome. Naranjo adverse drug reaction probability scale indicates a probable adverse effect due to capecitabine with seven points. A case of capecitabine-induced ventricular fibrillation arrest is reported, with a potential for type 1 Kounis syndrome as an underlying pathology supported by immunologic work up.

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A case of repeated Kounis syndrome after anaphylactic shock: A note for disease management

Kawaguchi,

Kuroshima,

Namba

et al. 2024

Acute Medicine & Surgery

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BackgroundKounis syndrome (KS) is an underdiagnosed disease. The management of the disease remains elusive because of its infrequency.Case PresentationA 78‐year‐old man with anaphylactic shock was admitted to our hospital 2 h after multiple bee stings. After recovering from an anaphylactic reaction, he presented with chest pain with ST elevation. We diagnosed him with KS. After a continuous intravenous infusion of vasodilators, his chest pain and ST elevation improved. However, chest pain with ST‐segment elevation recurred the next day. Coronary angiography revealed severe stenosis in the middle left anterior descending coronary artery, and drug‐eluting stents were implanted. The patient was discharged on foot after treatment for heart failure.ConclusionKS, in which anaphylaxis and acute coronary syndrome occur simultaneously, can recur repeatedly after an initial anaphylactic reaction; however, it could be delayed or it could present simultaneously with the anaphylactic reaction. Therefore, long‐term observation is important.

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Non-ST segment elevation myocardial infarction after multiple bee stings. A case of “delayed” Kounis II syndrome?

Cited by 14 publications

References 25 publications

Kounis syndrome: Acute myocardial injury caused by multiple bee stings

Kounis syndrome: Acute myocardial injury caused by multiple bee stings

Capecitabine-induced ventricular fibrillation arrest: Possible Kounis syndrome

A case of repeated Kounis syndrome after anaphylactic shock: A note for disease management

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