Journal of Emergency Medicine Case Reports

2149-9934

Acil Tıp Uzmanları Derneği

10.33706/jemcr.1126723

Clinical Sciences

Klinik Tıp Bilimleri

Kounis Syndrome That Recurs in A Short Time Period: A Case Report

https://orcid.org/0000-0001-6676-6517

Akbaş

İlker

KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNİVERSİTESİ, TIP FAKÜLTESİ

https://orcid.org/0000-0002-1678-4474

Kocak

Abdullah Osman

ATATURK UNIVERSITY, SCHOOL OF MEDICINE

https://orcid.org/0000-0002-6949-7233

Doğruyol

Sinem

Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey

12 27 2023

13 4 107 110 06 06 2022 11 08 2022

2010

Journal of Emergency Medicine Case Reports

This case report is unique for the occurrence of a quickly recurring Kounis Syndrome (KS) due to re-exposure to the same agent. A 40-year-old male was brought to our ED with a diagnosis of non-ST-segment elevation myocardial infarction. He stated that he had taken one dose of amoxicillin-clavulanate 1,000 mg at 03.00 AM. After taking the drug, chest pain and vomiting began. ECG which was taken at the the rural hospital, revealed a normal sinus rhythm with no ischemic changes. The value of cardiac troponin I 0.34 ng/ml in the rural hospital. The patient was consultated to the cardiology clinic with a pre-diagnosis of KS. Percutaneous coronary intervention showed that coronary arteries were normal and no plaque formation was found. The patient, who was diagnosed with type I KS, left the hospital at his own request at 14:12 PM. The patient presented to our ED again at 22:30 PM with chest pain and shortness of breath after accidentally using the same allergenic drug ~eight hours after leaving our hospital. ECG showed > 0.5 cm ST-segment elevation in leads DII, DIII, and aVF. Quickly recurring KS was due to accidental reuse of the same agent may be more severe than the first occurrence.

Kounis syndrome acute coronary syndrome allergic infarction recurring Kounis syndrome

1. Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract. 1991;45(2):121-8.

2. Akoz A, Bayramoglu A, Uzkeser M, Kantarci M, Aksakal E, Emet M. Two questions for Kounis syndrome: can we use magnetic resonance imaging in the diagnosis and does ST elevation correlates with troponin levels? Am J Emerg Med. 2012;30(9):2086 e5-7.

3. Katsanou K, Karagiannidis I, Oikonomou G, Kounis NG. Kounis syndrome: Report of 3 cases. Int J Cardiol. 2015;197:222-3.

4. Tanaka H, Urushima M, Hirano S, Takenaga M. An Acute Adverse Reaction with ST Elevation Induced by Magnetic Resonance Contrast Media: Kounis Syndrome. Intern Med. 2019;58(2):243-5.

5. Celiker M, Tuncer M, Sekeralmaz A. A Case with Repeated Recurrent Acute Coronary Syndrome due to Pseudoephedrine Use: Kounis Syndrome. Case Rep Med. 2014;2014:742905.

6. Barbarroja-Escudero J, Sanchez-Gonzalez MJ, Antolin-Amerigo D, Rodriguez-Rodriguez M, Salinas P, Fernandez-Ortiz A, et al. Kounis syndrome induced by cefditoren pivoxil. Int J Cardiol. 2016;207:112-4.

7. Gunaydin ZY, Bektas O, Akgedik R, Kaya A, Acar T. Recurrent Kounis syndrome. How should be the long-term treatment of Kounis syndrome? Int J Cardiol. 2014;177(3):1042-3.

8. Patane S, Marte F, Curro A, Cimino C. Recurrent acute myocardial infarction and Kounis syndrome. Int J Cardiol. 2010;142(2):e20-2.

9. Kounis NG, Tsigkas GG, Almpanis G, Kouni SN, Kounis GN, Mazarakis A. Suspected recurrent anaphylaxis in different forms during general anesthesia: implications for Kounis syndrome. J Anesth. 2011;25(5):790-1.

10. Imanishi H, Kitamura A, Maruyama K, Ariyama J, Nakagawa H, Nishibe S, et al. Suspected recurrent anaphylaxis in different forms during general anesthesia. J Anesth. 2010;24(1):143-5.

11. Tok D, Ozcan F, Senturk B, Golbasi Z. [A case of acute coronary syndrome following the use of parenteral penicillin: Kounis syndrome]. Turk Kardiyol Dern Ars. 2012;40(7):615-9.

12. Ferreira RM, Villela PB, Almeida JCG, Sampaio PPN, Albuquerque FN, Pinheiro FMC, et al. Allergic recurrent coronary stent thrombosis: A mini-review of Kounis syndrome. Cardiovasc Revasc Med. 2018;19(7 Pt B):890-5.

13. Fassio F, Losappio L, Antolin-Amerigo D, Peveri S, Pala G, Preziosi D, et al. Kounis syndrome: A concise review with focus on management. Eur J Intern Med. 2016;30:7-10.

14. Eyupoglu G, Tatli M, Bilmez KD, Guneysel O. Anaphylaxis and Kounis syndrome after using amoxicillin and clavulanic acid. J Int J Case Rep Images. 2015;6(4):207-10.

15. Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther. 2013;35(5):563-71.