A Case Report of Kounis Syndrome Developing Anaphylaxis Secondary to Vitamin B and C Infusion

Abstract

Kounis syndrome is a condition characterized by temporary coronary spasm, reduction in coronary blood flow and myocardial ischemia by activated mast cells as a result of an abnormal immune reaction to a drug or molecule. It is also called allergic angina and allergic myocardial infarction. It was first described by Kounis and Zarvas in 1991. (1) Kounis syndrome can be observed in all age groups regardless of the history of coronary artery disease. Kounis syndrome may occur due to environmental factors such as drugs, intracoronary stent implantation, foods, insect bites, bee stings, pollen, latex exposure etc. In our case report, acute coronary syndrome occurring during anaphylaxis secondary to vitamin B and C infusion, which is frequently used in clinical practice, will be explained.

Keywords

• kounis syndrome
• anaphylaxis
• vitamin

References

1. Kounis, N. G., and G. M. Zavras. "Histamine-induced coronary artery spasm: the concept of allergic angina." The British journal of clinical practice 45.2 (1991): 121-128.
2. Brown, Simon GA. "Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis." Current opinion in allergy and clinical immunology 5.4 (2005): 359-364.
3. Kounis, Nicholas G. "Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management." Clinical Chemistry and Laboratory Medicine (CCLM) 54.10 (2016): 1545-1559.
4. Nikolaidis, Lazaros A., Nicholas G. Kounis, and Alan H. Gradman. "Allergic angina and allergic myocardial infarction: a new twist on an old syndrome." The Canadian journal of cardiology 18.5 (2002): 508-511.
5. Chen, Jack P., et al. "Drug-eluting stent thrombosis: the Kounis hypersensitivity-associated acute coronary syndrome revis-ited." JACC: Cardiovascular Interventions 2.7 (2009): 583-593.
6. Fassio, Filippo, and Fabio Almerigogna. "Kounis syndrome (allergic acute coronary syndrome): different views in allergo-logic and cardiologic literature." Internal and emergency medicine 7.6 (2012): 489-495.
7. Ongun, Ebru Atike, et al. "Diagnostic Dilemma in Allergy and Coronary Syndromes: Kounis Syndrome or Adrenaline Effect?." Cocuk Acil ve Yogun Bakım 5.1 (2018): 25.
8. Giovannini, Mattia, et al. "Kounis syndrome: a clinical entity penetrating from pediatrics to geriatrics." Journal of Geriatric Cardiology: JGC 17.5 (2020): 294.