Type I Kounis syndrome variant: A case report and literature review

Abstract

Kounis syndrome defined as the occurrence of acute coronary syndrome in the setting of allergic reaction due to mast cells activation and inflammatory mediators release that induces coronary vasospasm, plaque erosion, or even stent thrombosis. A 25-year-old postpartum female with asthma and recurrent episodes of chest pain was admitted with ST-segment elevation myocardial infarction in the setting of coronary artery spasms. The patient was started on calcium channel blockers and nitrite-based medication with no improvement. She was noted to have eosinophilia and initiation of corticosteroid-based regimen lead to resolution of chest pain episodes and normalization of eosinophilia. Kounis syndrome should be considered in young patients with chest pain. Coronary vasodilators are considered as the first-line of treatment. The use of corticosteroids has been described in the literature in severe or refractory cases.

Kounis Syndrome: An Allergic Acute Coronary Syndrome Due to a Bee Sting

“…Type 2 variant affects patients with pre-existing atheromatous disease in whom mediator-induced vasospasm is accompanied by plaque erosion or rupture that manifests as an acute myocardial infarction. Type 3 variant is seen in patients with coronary artery stent thrombosis secondary to eosinophils and mast cell activation [ 3 ].…”

“…Effective Kounis syndrome management entails treating anaphylaxis while maintaining adequate myocardial perfusion [ 3 , 5 ]. The initial goal of treatment should be to prevent life-threatening anaphylaxis while keeping in mind that some medications may affect coronary blood flow.…”

“…Allergic angina, also known as Kounis syndrome, is believed to be caused by the release of inflammatory mediators such as histamine, platelet-activating factor, leukotrienes, neutral proteases, and a variety of cytokines and chemokines during an allergic reaction. These mediators have the potential to trigger either coronary artery spasm or an immediate coronary thrombosis that may lead to acute myocardial injury [1][2][3].…”

Contrast Media Induced Kounis Syndrome: A Case Report

“…Type I variant is characterized by allergy-related coronary spasm without coronary lesions or risk factors. Patients with type I Kounis syndrome present electrocardiographic change with or without cardiac enzymes elevation due to the acute release of inflammatory mediators inducing coronary spasm [4]. The type II variant includes pre-existing atheromatous disease.…”

New Fatal Case of Kounis Syndrome Triggered by Metamizole: A Case Report

“…For the treatment of the allergic reaction, both H1 and H2 antihistamines, such as diphenhydramine (1 to 2 mg/kg) and ranitidine (1 mg/kg) can be used. The use of H1 receptor blockers has been suggested in Kounis syndrome but in a low flow rate because these drugs can precipitate hypotension and compromise coronary flow [11]. Corticoids are an important part of the treatment of anaphylaxis but they may impair wound healing causing myocardial wall thinning and cardiac aneurysms.…”