From Anaphylaxis to Acute Myocardial Infarction: Type II Kounis Syndrome Caused by Ceftriaxone

Öz

A 70-year-old male patient with a history of hypertension and previous NSTEMI presented to the emergency department with throat pain. Ceftriaxone therapy was initiated based on a suspected cryptic tonsillitis. After receiving 5-10 cc of the drug, the patient developed sudden changes in consciousness and hypotension. The ECG showed widespread ST depression in leads V2-6 and elevated troponin-I (1928.3 pg/mL).Coronary angiography performed after anaphylaxis treatment revealed critical stenoses of 80% in the left main coronary artery, 90% in the LAD, 80% in the circumflex, and 99-100% in the right coronary artery. The acute myocardial infarction secondary to the allergic reaction was classified as Kounis syndrome Type II. The patient underwent successful percutaneous coronary intervention and was discharged in stable condition.This case demonstrates that antibiotic allergy can lead to life-threatening cardiac complications in the presence of underlying coronary artery disease.

Anahtar Kelimeler

• Anaphylaxis
• Ceftriaxone
• Kounis Syndrome
• Myocardial Infarction

Anafilaksiden Akut Miyokard İnfarktüsüne: Seftriakson Kaynaklı Tip II Kounis Sendromu

Öz

Yetmiş yaşında, hipertansiyon ve geçirilmiş NSTEMI öyküsü olan erkek hasta, boğaz ağrısı nedeniyle acil servise başvurdu. Kriptik tonsilit düşünülerek seftriakson tedavisi başlandı. İlacın 5-10 cc'si verildiğinde hastada ani bilinç değişikliği ve hipotansiyon gelişti. EKG'de V2-6 derivasyonlarında yaygın ST depresyonu ve Troponin-I yüksekliği (1928,3 pg/mL) saptandı.Anafilaksi tedavisi sonrası yapılan koroner anjiyografide sol ana koroner arterde %80, LAD'de %90, sirkumflekste %80, sağ koroner arterde %99-100 kritik darlıklar tespit edildi. Alerjik reaksiyona sekonder gelişen akut miyokard infarktüsü, Kounis sendromu Tip II olarak değerlendirildi. Hastaya başarılı perkütan koroner girişim uygulandı ve stabil seyrederek taburcu edildi.Bu olgu, antibiyotik alerjisinin mevcut koroner arter hastalığı zemininde hayatı tehdit eden kardiyak komplikasyonlara yol açabileceğini göstermektedir.

Anahtar Kelimeler

• Anafilaksi
• Kounis Sendromu
• Miyokard İnfartüsü
• Seftriakson

Kaynakça

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