Abstract:Background
Kounis syndrome is the occurrence of acute coronary syndrome precipitated by an allergic reaction in the presence or absence of underlying coronary artery disease. The syndrome is explained by the effect of released inflammatory mediators on the coronary arteries and platelets.
Case summary
We report an uncommon case of Kounis syndrome Type II in a 65-year-old man 24 h after being bitten by a hymenoptera. Clinical … Show more
“…Stress-induced cardiomyopathy should be considered in the differential diagnosis of Kounis syndrome since these two clinical conditions can coexist, forming the so-called “adrenaline-takotsubo-anaphylaxis-Kounis (ATAK complex)”, and allergic myocarditis should also be distinguished ( 13 ). New imaging techniques such as dynamic contrast-enhanced cardiac magnetic resonance imaging and myocardial single-photon emission computed tomography can also assist in the diagnosis ( 14 , 15 ). Additionally, research has also indicated that performing flow cytometry-based proliferation assay in vitro can better elucidate the association between drugs and allergic reactions ( 16 ).…”
BackgroundKounis syndrome is a specific type of acute coronary syndrome caused by allergic or hypersensitivity response. Clinical knowledge about this syndrome is insufficient. We report a case in which intravenous administration of flurbiprofen resulted in Type I Kounis syndrome.Case summaryA 60-year-old female patient with no history of coronary artery disease developed limb erythema, hypotension, and chest tightness after receiving intravenous flurbiprofen. Electrocardiogram showed ST segment elevation in leads II, III, and aVF. Emergency coronary angiography revealed no significant stenosis or thrombus in the coronary arteries. Subsequent echocardiography showed no apparent abnormalities. Levels of troponin T were elevated. The diagnosis was flurbiprofen-induced Type I Kounis syndrome, presenting as acute ST segment elevation myocardial infarction.ConclusionsPatients with Kounis syndrome can exhibit severe clinical symptoms, and their condition may even be life-threatening. It is important for clinicians to have a thorough understanding of this syndrome in order to develop comprehensive treatment plans.
“…Stress-induced cardiomyopathy should be considered in the differential diagnosis of Kounis syndrome since these two clinical conditions can coexist, forming the so-called “adrenaline-takotsubo-anaphylaxis-Kounis (ATAK complex)”, and allergic myocarditis should also be distinguished ( 13 ). New imaging techniques such as dynamic contrast-enhanced cardiac magnetic resonance imaging and myocardial single-photon emission computed tomography can also assist in the diagnosis ( 14 , 15 ). Additionally, research has also indicated that performing flow cytometry-based proliferation assay in vitro can better elucidate the association between drugs and allergic reactions ( 16 ).…”
BackgroundKounis syndrome is a specific type of acute coronary syndrome caused by allergic or hypersensitivity response. Clinical knowledge about this syndrome is insufficient. We report a case in which intravenous administration of flurbiprofen resulted in Type I Kounis syndrome.Case summaryA 60-year-old female patient with no history of coronary artery disease developed limb erythema, hypotension, and chest tightness after receiving intravenous flurbiprofen. Electrocardiogram showed ST segment elevation in leads II, III, and aVF. Emergency coronary angiography revealed no significant stenosis or thrombus in the coronary arteries. Subsequent echocardiography showed no apparent abnormalities. Levels of troponin T were elevated. The diagnosis was flurbiprofen-induced Type I Kounis syndrome, presenting as acute ST segment elevation myocardial infarction.ConclusionsPatients with Kounis syndrome can exhibit severe clinical symptoms, and their condition may even be life-threatening. It is important for clinicians to have a thorough understanding of this syndrome in order to develop comprehensive treatment plans.
“…Regional wall motion abnormalities on the echocardiogram often mirror the impairment in blood flow distribution of the afflicted artery. 42 Figure 2 ECG features in Kounis syndrome, demonstrating sinus rhythm, normal cardiac axis, diffuse coved and saddleback ST elevations in leads II, III, aVF and ST segment depression in leads I and aVL. …”
Section: Ecg Features In Kounis Syndromementioning
confidence: 99%
“…Regional wall motion abnormalities on the echocardiogram often mirror the impairment in blood flow distribution of the afflicted artery. 42 Treatment in Kounis syndrome may be challenging since it must concurrently address both cardiac and allergic symptoms, and medications used may exacerbate the allergy and impair heart function. 25,[43][44][45][46] Whereas patients with KS can expect a full recovery with the appropriate care, fatal cases have been reported.…”
Section: Ecg Features In Kounis Syndromementioning
Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.
“…Acute coronary syndromes associated with anaphylaxis are also known as Kounis syndrome and is extensively described following wasp stings [79]. Cardiac MRI in such instances will show enhancement in the affected myocardium [80]. A case of silent ST elevated myocardial infarction was reported in a patient without autonomic neuropathy or coronary atherosclerosis [81].…”
Background
Wasp stinging, a neglected tropical entity can have a myriad of local and systemic effects. We present a case of multi-organ injury following multiple wasp stings and a review of literature on the systemic manifestations of wasp stings.
Case presentation
A 48-year-old Sri Lankan male who suffered multiple wasp stings, developed an anaphylactic shock with respiratory failure, which was treated with adrenaline and mechanical ventilation. Within the next 2 days the patient developed acute fulminant hepatitis, stage III acute kidney injury, rhabdomyolysis, haemolysis and thrombocytopenia. The patient was treated in the intensive care unit with ionopressors and continuous renal replacement therapy (CRRT). Haemoadsorbant therapy was used in adjunct with CRRT. There was a gradual recovery of the organ functions over the 1st week. However, the patient succumbed to fungal sepsis on the 16th day despite treatment. We conducted a literature review to identify the various clinical manifestations of wasp stinging. Wasp venom contains enzymes, amines, peptides and other compounds. These proteins can cause type 1 hypersensitive reactions ranging from local skin irritation to anaphylactic shock. Furthermore, the toxins can cause direct organ injury or delayed hypersensitivity reactions. The commonly affected organs are the kidneys, liver, and muscles. The effect on the haematological system manifests as coagulopathy and/or cytopenia. The heart, nervous system, lungs, intestines and skin can be affected rarely. Treatment is mainly supportive.
Conclusion
In conclusion, wasp envenomation can result in multi-organ injury and attention should be paid in doing further research and establishing evidence-based treatment practices.
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