Management of Kounis syndrome: two case reports

• Published in: Journal of medical case reports Vol. 11; no. 1; p. 145
• Main Authors: Omri, Majdi, Kraiem, Hajer, Mejri, Olfa, Naija, Mounir, Chebili, Naoufel
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.05.2017; BioMed Central; BMC
• Subjects: Acute coronary syndrome; Acute coronary syndromes; Amoxicillin - administration & dosage; Amoxicillin - adverse effects; Anaphylaxis; Anaphylaxis - chemically induced; Anaphylaxis - physiopathology; Angina pectoris; Angioplasty; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - adverse effects; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Aspirin - therapeutic use; Cardiology; Cardiovascular disease; Care and treatment; Case Report; Case reports; Case studies; Chest Pain - chemically induced; Chest Pain - physiopathology; Clopidogrel; Coma; Coronary vessels; Dexamethasone - administration & dosage; Dexamethasone - adverse effects; Diagnosis; Electrocardiography; Emergency medical care; Emergency services; Funding; Guidelines as Topic; Heart attacks; Humans; Kounis syndrome; Kounis Syndrome - diagnosis; Kounis Syndrome - drug therapy; Kounis Syndrome - physiopathology; Male; Management; Middle Aged; Pain; Platelet Aggregation Inhibitors - therapeutic use; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Treatment Outcome; Vital signs; Case report; Anaphylaxis; Management; Acute coronary syndrome; Kounis syndrome
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-017-1310-7

Kounis syndrome corresponds to the occurrence of myocardial injury following an allergic insult. This syndrome is infrequent, and is not well known. In consequence, it is usually misdiagnosed leading to inappropriate treatment. The current literature is limited to case studies and there are no international recommendations concerning this topic. We discussed, through two case reports, the clinical presentation and the management of a 60-year-old North African man and a 45-year-old North African man presenting with chest pain suggesting acute coronary syndrome following anaphylactic reaction. Triggering factors were a drug in the first case and herbal dermal exposure in the second. A clinical examination and electrocardiogram revealed anaphylactic reaction associated with myocardial infarction. Appropriate management of these two life-threatening conditions allowed an improvement in our patients' condition and their transfer to specialized units. Although Kounis syndrome is a rare phenomenon, physicians should be aware of its physiopathological mechanisms in order to treat it appropriately. The difficulty lies in the fact that the treatment of either of the two associated entities may worsen the other injury.