Arı Sokmasına Bağlı Genç Hastada Kounis Sendromu: Olgu Sunumu

Abstract

Böcek sokmaları hipersensivite reaksiyonu ile basit bir ürtikerden miyokard infarktüsüne kadar gidebilen değişik klinik durumlara sebeb olmaktadır. Böcek sokmalarının neden olduğu akut koroner sendromlara Kounis sendromu denmektedir. Miyokard infarktüsü (Mİ) tüm dünyadaki mortalite ve morbiditenin en yaygın sebeplerinden biridir. Kırk üç yaşında erkek hasta arı sokmasını takiben şiddetli göğüs ağrısı yakınması ile acil servise başvurdu. Fizik muayenesinde kan basıncı 85/50 mm/Hg, nabız 60/dk idi. Hastanın çekilen EKG’sinde anterior derivasyonlarda (V1-V6) belirgin ST yükselmesi mevcuttu. Antihistaminik ve steroid tedavisinden 15 dakika sonra çekilen EKG’de anterior derivasyonlardaki ST segment elevasyonlarının gerilediği tespit edildi. Akut anterior MI tanısı ile kateter laboratuarına alınan hastada sol ön inen arter (LAD) proksimalinde %80 lezyon tespit edildi. Sonuç olarak arı sokması sonrasında acil servise başvuran hastalarda Kounis sendromunun da göz önünde bulundurularak antihistaminik ve steroid grubu ilaçların kullanılması düşünülmelidir.

Keywords

• Akut koroner sendrom, böcek ısırığı, allerjik reaksiyon

Kounis Syndrome in a Young Patient After Bee Sting: Case Report

Abstract

Hypersensitivity reactions due to insect bites cause different clinical situations ranging from simple urticaria to myocardial infarction. Acute coronary syndrome caused by insect bites is called Kounis syndrome. Myocardial infarction (MI) is one of the most common causes of mortality and morbidity in the world. Following a bee sting, a 43-year-old male patient was admitted to the emergency room with severe chest pain. Upon physical examination of the patient, blood pressure was 85/50 mm/Hg, heart rate was 60 beats/minute and respiratory rate was 12/minute. The ECG of the patient showed a significant ST elevation in anterior derivations. Treatment was started with intravenous antihistamines and steroids. After fifteen minutes, decreased ST segment elevation in anterior derivations were detected on the ECG of patient. Coronary angiography revealed 80% stenosis in the left anterior descending artery (LAD). As a result, we suggest that emergency room physicians should consider the use of antihistamines and steroids in with to bee stings in Kounis syndrome patients

Keywords

• Acute coronary syndrome, insect bites, allergic reaction

References

1. Freeman TM. Clinical practice. Hypersensitivity to hymenoptera stings. N Engl J Med 2004; 351: 1978-84. [CrossRef]
2. Kounis NG. Kounis syndrome (allergic angina and allergic myocardial in- farction): a natural paradigm? Int J Cardiol 2006; 110: 7-14. [CrossRef]
3. Kogias JS, Sideris SK, Anifadis SK. Kounis syndrome associated with hyper- sensitivity to hymenoptera stings. Int J Cardiol 2007; 114: 252-5. [CrossRef]
4. White HD, Chew DP. Acute myocardial infarction. Lancet 2008; 372: 570-84. [CrossRef]
5. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation 1995; 92: 657-71. [CrossRef]
6. Libby P. Current concepts of the pathogenesis of the acute coronary syn- dromes. Circulation 2001; 104: 365-72. [CrossRef]
7. Collinson PO, Premachandram S, Hashemi K. Prospective audit of inci- dence of prognostically important myocardial damage in patients dis- charged from emergency department. BMJ 2000; 320: 1702-5. [CrossRef]
8. Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract 1991; 45: 121-8.

9. Mytas DZ, Stougiannos PN, Zairis MN, Tsiaousis GZ, Foussas SG, Hahalis GN, et al. Acute anterior myocardial infarction after multiple bee stings. A case of Kounis syndrome. Int J Cardiol 2009; 134: 129-31. [CrossRef]
10. Schmidt R, Bultmann A, Ungerer M, Joghetaei N, Bulbul O, Thieme S, et al. Extracellular matrix metalloproteinase inducer regulates matrix metal- loproteinase activity in cardiovascular cells: implications in acute myocar- dial infarction. Circulation 2006; 113: 834-41. [CrossRef]
11. Nikolaidis LA, Kounis NG, Gradman AH. Allergic angina and allergic myo- cardial infarction: a new twist on an old syndrome. Can J Cardiol 2002; 18: 508-11.
12. Erbilen E, Gulcan E, Albayrak S, Ozveren O. Acute myocardial infarction due to a bee sting manifested with ST wave elevation after hospital ad- mission. South Med J 2008; 101: 448. [CrossRef]
13. Massing JL, Bentz MH, Schlesser P, Dumitru C, Louis JP. [Myocardial infarc- tion following a bee sting. Apropos of a case and review of the literature]. Ann Cardiol Angeiol 1997; 46: 311-5.