Penicillin allergy in cancer patients manifesting as Kounis syndrome

Abstract

Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) following penicillin administration are described. The patients suffered from lung and mandible neoplasms and had previously received several courses of antineoplastic therapy without any sequelae. One patient had normal coronary arteries (type I variant of the syndrome) and the other had coronary artery disease with previous myocardial infarction (type II variant of the syndrome). The allergic reaction following penicillin administration seemed to have triggered the development of an acute coronary artery spasm in the first patient and an acute myocardial infarction in the second. This report shows that susceptible individuals expressing a magnified mast cell degranulation effect may be more vulnerable to coronary artery spasm and plaque erosion or rupture.

Kounis syndrome secondary to amoxicillin/clavulanic acid use

“…Two of them had developed after taking oral ACA in patients who had normal coronary arteries [8,9]. The third case had progressed after intravenous penicillin use in a cancer patient [7]. All of them were concordant with type-I of KS.…”

“…In previous reports, only three ACA-induced KS cases were reported [7][8][9]. Two of them had developed after taking oral ACA in patients who had normal coronary arteries [8,9].…”

Coronary spasm and hypersensitivity to amoxicillin: Kounis or not Kounis syndrome?

“…These favour vasoconstriction, collagen destruction and plaque erosion or rupture, which may trigger an acute coronary syndrome [1,2]. In fact, high levels of histamine have been found in patients with vasospastic angina [4], although no definitive studies have shown a causal relationship between the allergic reaction and the ensuing acute coronary syndrome [5].…”

“…It has been recently described that the onset of allergic phenomena in predisposed subjects can trigger an angina episode [1,2]. The association of acute coronary syndrome and hypersensitivity reactions has been described as Kounis syndrome [3].…”

“…Type I happens in patients with normal coronary arteries, which might represent a manifestation of endothelial dysfunction or microvascular angina. In type II, coronary spasm occurs in patients with culprit but quiescent pre-existing atheromatous disease [2,3].…”