1
|
Pejcic AV, Milosavljevic MN, Jankovic S, Davidovic G, Folic MM, Folic ND. Kounis Syndrome Associated With the Use of Diclofenac. Tex Heart Inst J 2023; 50:490621. [PMID: 36735919 PMCID: PMC9969777 DOI: 10.14503/thij-21-7802] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Diclofenac is a widely used analgesic, anti-inflammatory, antipyretic drug. In several case reports, its use was associated with the occurrence of Kounis syndrome. The aim of this review was to investigate and summarize published cases of Kounis syndrome suspected to be associated with the use of diclofenac. METHODS Electronic searches were conducted in PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, and the Serbian Citation Index. RESULTS Twenty publications describing the 20 patients who met inclusion criteria were included in the systematic review. Specified patient ages ranged from 34 to 81 years. Eighteen (90.0%) patients were male. Five patients (25.0%) reported a previous reaction to diclofenac. Reported time from the used dose of diclofenac to onset of the first reaction symptoms ranged from immediately to 5 hours. Diclofenac caused both type I and type II Kounis syndrome, with the presence of various cardiovascular, gastrointestinal, dermatologic, and respiratory signs and symptoms. Most patients experienced hypotension (n = 15 [75.0%]) and chest pain (n = 12 [60.0%]). The most frequently reported finding on electrocardiogram was ST-segment elevations (n = 17 [85.0%]). Coronary angiogram showed normal coronary vessels in 9 patients (45.0%), with some pathologic findings in 8 patients (40.0%). CONCLUSION Clinicians should be aware that Kounis syndrome may be an adverse effect of diclofenac. Prompt recognition and withdrawal of the drug, with treatment of both allergic and cardiac symptoms simultaneously, is important.
Collapse
Affiliation(s)
- Ana V. Pejcic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milos N. Milosavljevic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
,Clinical Pharmacology Department, University Clinical Centre Kragujevac, Kragujevac, Serbia
| | - Goran Davidovic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marko M. Folic
- Clinical Pharmacology Department, University Clinical Centre Kragujevac, Kragujevac, Serbia
,Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Nevena D. Folic
- Pediatric Clinic, University Clinical Centre Kragujevac, Kragujevac, Serbia
,Department of Pediatrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| |
Collapse
|
2
|
Abstract
Allergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.
Collapse
|
3
|
Erdogan E, Cap M, Kus G, Gokhan C, Kilic Y. An unusual case of concurrent Kounis syndrome and prolonged QT in a young patient. Cardiol Young 2022; 32:824-826. [DOI: https:/doi.org/10.1017/s1047951121003838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
AbstractAllergic reactions related to drug use is a common entity presenting often from minor urticaria to life-threatening anaphylactoid reactions. A common but easily overlooked diagnosis, Kounis syndrome, is an established hypersensitivity coronary disorder induced by drugs, foods, environmental factors, and coronary stents that can present in the same way as non-allergy-induced acute coronary syndrome. Here within, we present a unique case of dual presentation of Kounis syndrome and prolonged QTc in a young patient after a single dose of Domperidone and Lansoprazole.
Collapse
|
4
|
Dai B, Cavaye J, Judd M, Beuth J, Iswariah H, Gurunathan U. Perioperative presentations of Kounis syndrome: a systematic literature review. J Cardiothorac Vasc Anesth 2022; 36:2070-2076. [DOI: 10.1053/j.jvca.2022.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 11/11/2022]
|
5
|
Tiwari R, Singh M, Srivastava T, Pandey C. Cefuroxime hypersensitivity leading to myocardial ischaemia. Indian J Anaesth 2022; 66:S178-S179. [PMID: 35774238 PMCID: PMC9238235 DOI: 10.4103/ija.ija_168_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/23/2022] Open
|
6
|
Sato M, Arai T. A case of Kounis syndrome presenting as coronary artery spasm associated with cefazolin-induced anaphylaxis during general anesthesia. JA Clin Rep 2019; 5:49. [PMID: 32026020 PMCID: PMC6966758 DOI: 10.1186/s40981-019-0269-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/23/2019] [Indexed: 11/10/2022] Open
Abstract
Background Kounis syndrome (KS) is defined as the occurrence of acute coronary syndrome (ACS) associated with an anaphylactic reaction, and there have only been a few reports of its occurrence under general anesthesia. Case presentation A 69-year-old woman underwent transurethral resection of a bladder tumor under general anesthesia. Cefazolin was administered intravenously after induction of general anesthesia. During the operation, we suspected ACS from sudden ST segment depression on electrocardiogram. The delayed onset of an erythematous rash reminded us of the anaphylactic reaction of KS. Coronary artery spasm of type 1 KS was diagnosed based upon the findings of coronary computerized tomography. Eleven days after the first surgery, the patient underwent nephroureterectomy uneventfully by a change in antibiotics. Finally, cefazolin proved to be the trigger drug by the intradermal test. Conclusion When electrocardiogram changes suggesting ACS occur during general anesthesia, it is necessary to take KS into consideration as a differential diagnosis.
Collapse
Affiliation(s)
- Masami Sato
- Department of Anesthesia, Kyoto City Hospital, 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845, Japan.
| | - Toshiyuki Arai
- Department of Anesthesia, Kyoto City Hospital, 1-2 Mibuhigashitakada-cho, Nakagyo-ku, Kyoto, 604-8845, Japan
| |
Collapse
|
7
|
Shibuya K, Kasama S, Funada R, Katoh H, Tsushima Y. Kounis syndrome induced by contrast media: A case report and review of literature. Eur J Radiol Open 2019; 6:91-96. [PMID: 30805421 PMCID: PMC6374503 DOI: 10.1016/j.ejro.2019.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/05/2019] [Accepted: 02/05/2019] [Indexed: 12/21/2022] Open
Abstract
Kounis syndrome (KS) is an acute coronary disorder associated with anaphylactic reactions. The purpose of this report is to identify the features of KS triggered by contrast media on the basis of our experience and from literature review. We have described a case and literature review of KS triggered by injection of contrast media. Including the present case, we reviewed eleven cases of KS. Six cases developed KS in diagnostic radiology departments. KS could be induced by intravenous injection of contrast media in the radiology department. Radiologists should recognize this critical condition to ensure appropriate management.
Collapse
Affiliation(s)
- Kei Shibuya
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.,Gunma University Heavy Ion Medical Center, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Shu Kasama
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Ryuichi Funada
- Department of Medicine and Biological Science (Cardiovascular Medicine), Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hiroyuki Katoh
- Gunma University Heavy Ion Medical Center, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
8
|
Drug-induced Kounis syndrome: A matter of pharmacovigilance. Int J Cardiol 2018; 274:381. [PMID: 30057169 DOI: 10.1016/j.ijcard.2018.07.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/23/2018] [Indexed: 11/22/2022]
|
9
|
Mota I, Gaspar Â, Morais-Almeida M. Perioperative Anaphylaxis Including Kounis Syndrome due to Selective Cefazolin Allergy. Int Arch Allergy Immunol 2018; 177:269-273. [PMID: 29913447 DOI: 10.1159/000490182] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Perioperative use of cefazolin has been associated with severe allergic reactions, and patients are usually labelled as allergic to penicillin afterwards. The aim of our study was to describe a group of patients with immediate reactions to cefazolin, with proven selective hypersensitivity reactions. METHODS Systematic review of all patients followed at our drug centre with cefazolin-related reactions, between January 2012 and December 2016. All patients were investigated according to the European Network for Drug Allergy (ENDA) recommendations through skin testing (major and minor penicillin determinants, penicillin, amoxicillin, cefazolin, cefuroxime and ceftriaxone) and oral challenges tests. RESULTS We included 7 patients (median age 40 years) with perioperative anaphylactic reactions immediately after cefazolin injection, 4 with hypotension and 1 with Kounis syndrome (KS) type I. The presence of a selective IgE-mediated hypersensitivity through positive skin tests to cefazoline has been proven in all patients. Two patients experienced systemic reactions during skin testing. All patients were successfully challenged with amoxicillin, and they tolerated cefuroxime. CONCLUSIONS Cefazolin can be responsible for immediate severe allergic reactions in perioperative setting, including KS. Allergological workup is essential for an accurate diagnosis and to explore cross-reactivity between cefazolin and other beta-lactams. Our experience confirmed that patients with IgE-mediated hypersensitivity reactions to cefazolin can tolerate other beta-lactams. This selective pattern of clinical reactivity may be explained by its particular chemical structure, whose R1 side-chain is different from other beta-lactams.
Collapse
|
10
|
Pradhan S, Christ M, Trappe HJ. Kounis syndrome induced by amoxicillin following vasospastic coronary event in a 22-year-old patient: a case report. Cardiovasc Diagn Ther 2018; 8:180-185. [PMID: 29850410 DOI: 10.21037/cdt.2018.03.07] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reports the case of a 22-year-old male patient presented with electrocardiographic ST elevation and elevated cardiac biomarkers. The clinical cascade set into events within an hour of administration of a single-dose of amoxicillin on being diagnosed with acute tonsillitis. The case was preliminarily diagnosed and treated according to the acute coronary syndrome protocol, but on performing coronary angiography no abnormalities in the coronary artery were found. Acute myocarditis was excluded in cardiac MRI. Considering possible hypersensitive reaction of amoxicillin in the absence of major cardiovascular risk in the young patient, diagnosis of Kounis syndrome (KS) was inferred. A thorough clinical observation of the patient after stopping the administration of amoxicillin revealed that there was a resolution of ST-elevation towards baseline. It coincided with falling cardiac biomarkers concomitant with subsided pain. The asymptomatic patient was discharged after 5 days of hospital stay. Telephonic follow-up one week after discharge from the hospital confirmed his pain-free and overall normal clinical status. Aim of the present report is to emphasize the need for increased awareness of KS induced by amoxicillin.
Collapse
Affiliation(s)
- Snehasis Pradhan
- Department of Cardiology and Angiology, Marien Hospital, Herne, University of Bochum, Herne, Germany
| | - Martin Christ
- Department of Cardiology and Angiology, Marien Hospital, Herne, University of Bochum, Herne, Germany
| | - Hans-Joachim Trappe
- Department of Cardiology and Angiology, Marien Hospital, Herne, University of Bochum, Herne, Germany
| |
Collapse
|
11
|
Martinez E, Sahni S, Cheema MA, Iftikhar A. Vancomycin-induced coronary artery spasm: a case of Kounis syndrome. BMJ Case Rep 2018; 2018:bcr-2017-222846. [PMID: 29348285 DOI: 10.1136/bcr-2017-222846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Eric Martinez
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Sonu Sahni
- Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Muhammad Ai Cheema
- Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA
| | - Asma Iftikhar
- Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA
| |
Collapse
|