Kounis syndrome: Report of 3 cases

Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review

Kounis syndrome (KS), recognized as a rare yet significant form of acute coronary syndrome precipitated by allergy-mediated mechanisms, poses diagnostic challenges due to its varied clinical presentations and under-recognition. Despite its relevance across diverse populations, comprehensive insights into age-specific characteristics and management remain limited. The analysis of 420 studies yielded a total of 466 case reports of Kounis syndrome, categorized into pediatric (n = 31) and adult (n = 435) populations. After rigorous screening, 330 adult and 20 pediatric case reports were included for further analysis. Triggering factors were identified, with drugs (other) being the most prevalent in both groups. The breakdown of triggering factors, such as drugs (antibiotics), bee/wasp stings, and contrast media, was elucidated. Variations in presenting symptoms, diagnostic investigations, and treatment modalities between pediatric and adult populations were observed. Notably, all pediatric cases were diagnosed with subtype I Kounis syndrome and demonstrated favorable outcomes without any reported fatalities, whereas adult cases exhibited a broader range of Kounis subtypes. Mortality was recorded solely in adult case reports, with no fatalities reported among pediatric cases. These findings underscore the importance of understanding the nuances in the clinical presentation and management of Kounis syndrome across different age groups.

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

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.

Vancomycin-induced coronary artery spasm: a case of Kounis syndrome

Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.