Non-Steroidal Anti-Inflammatory Drug Induced Kounis Syndrome

Öz

Kounis syndrome is a very rare syndrome which includes anaphylactic, anaphylactoid and hypersensitivity reactions accompanied with mast cell activation and acute coronary syndrome. In this case we aimed to define kounis syndrome.

A 68 years old male patient applied to emergency department with back pain. After administration of the intramuscular analgesic; the patient suffered from symptoms such as dizziness, burning sensation all over the body. Patient was examined and blood pressure was 75/45 mmHg, heart rate was 90 beats/minute and respiratory rate was 14 /minute. The patient was detected with hyperemic skin and minimal uvular edema. Electrocardiography findings were ST segment elevations at derivations D2, D3, aVF, V5, V6 and ST segment depressions at derivations V1, V2, V3, D1, aVL. After percutaneous coronary angiography, coronary arteries were detected normal. The patient, newly diagnosed with acute coronary syndrome after allergen exposure, with positive skin findings and hypotension was evaluated as Kounis syndrome.

There are 3 types of Kounis syndrome. These are defined as vasospastic allergic angina, allergic myocardial infarction and eosinophil and mast cell infiltration related stent thrombosis. The patient, without abnormal coronary arteries findings, was detected with coronary artery syndrome secondary to vasospasm.

Increased exposure to allergens, increased awareness of physicians about Kounis syndrome, overconsumption of medicines contributes to increase this syndrome. The incidence of Kounis Syndrome has increasing but diagnosis of Kounis Syndrome is inadequate and easily overlooked. Most of all patients, presented with allergic reactions, should be evaluated for Kounis syndrome.

Anahtar Kelimeler

• Kounis Syndrome,Allergy,Vasospasm

Non Steroid Anti Enflamatuar İlacın Tetiklediği Kounis Sendromu

Öz

Kounis sendromu anafilaktik, anafilaktoid ve aşırı duyarlılık reaksiyonlarını içeren mast hücre aktivasyonu ile akut koroner sendromun birlikte bulunduğu nadir görülen bir sendromdur.

Kounis sendromlu vakayı tanımlamayı amaçladık.

68 yaşında erkek hasta acil servise sırt ağrısı nedeni ile başvurdu. İntramusküler analjezik tedavisi sonrası halsizlik, tüm vücutta yanma gibi semptomlar gelişti. Hastanın fizik muayenesinde kan basıncı 75/45 mmHg, kalp hızı 90 atım/dakika ve solunum hızı dakikada 14 idi. Cilt hiperemik ve uvulada ödem mevcuttu. Elektrokardiyografide D2,D3,aVF,V5,V6 derivasyonlarında ST segment elevasyonu, V1,V2,V3, D1,aVL derivasyonlarında ST segment depresyonları mevcuttu. Perkutanöz koroner anjiografi sonrası koroner arterleri normal olarak tespit edildi. Alerjen maruziyeti sonrası akut koroner sendrom gelişen ve cilt bulguları ve hipotansiyonu olan hasta kounis sendromu olarak değerlendirildi.

Kounis sendromunun; vazospastik alerjik anjina, alerjik miyokardiyal enfarkt, eozinofil ve mast hücreleri infiltrasyonuna bağlı stent trombozu olmak üzere üç varyantı bulunmaktadır. Koronerleri normal olan hastamızda vazospazma bağlı akut koroner sendrom görüldü.

Alerjenlere artan maruziyet, hekimlerin kounis sendromunun konusunda artmış farkındalıkları, ilaç tüketimini artmış olması bu sendromun artmasına katkıda bulunmaktadır. Kounis sendromunun insidansı artmaktadır fakat tanısı yetersiz ve kolayca gözden kaçmaktadır. Alerjik reaksiyonlarla prezente olan hastalar kounis sendromu için değerlendirilmelidirler.

Anahtar Kelimeler

• Kounis Sendromu,Alerji,Vazospazm

Kaynakça

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