Cefuroxime-induced coronary artery spasm manifesting as Kounis syndrome (original) (raw)
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A Rare Case of Ceftriaxone Induced Coronary Spasm with Acute Myocardial Ischemia
Journal of Evolution of medical and Dental Sciences, 2014
Kounis syndrome has been known as allergic angina and/or allergic myocardial infarction. Allergic insults usually may include drugs, latex, and food. Although ceftriaxone administration has been associated with various allergic reactions such as urticaria, angioedema, erythema, rash and anaphylactic shock, there are very few published report that has shown an association between ceftriaxone use and Kounis syndrome. Here, we describe a case report of allergic vasospasm, leading to acute anterior wall myocardial infarction, probably as the result of an acute allergic reaction, after ceftriaxone use.
Kounis Syndrome secondary to cefuroxime axetil use in an asthmatic patient
International Journal of Cardiology, 2009
A sixty-one year old female with a past history of asthma was admitted to the emergency department because of vertigo, nausea, vomiting, chest pain and generalized erythema after taking an oral dose of cefuroxime axetil. Electrocardiography showed ST segment elevation in inferior leads. After coronary angiography, type 2 variant of Kounis Syndrome is diagnosed. We present first drug induced Kounis Syndrome in an asthmatic patient with severe anaphylactic shock. The present report also shows that atopic people expressing an amplified mast cell degranulation may have more serious hemodynamic decompensation during hypersensitivity reactions.
Internal and emergency medicine, 2012
The clinical picture of myocardial ischemia accompanying allergic reactions is defined in the cardiologic literature as Kounis syndrome (KS) or allergic angina/myocardial infarction. In PubMed, a search for "Kounis syndrome", "allergic angina" or "allergic myocardial infarction" retrieves more than 100 results (among case reports, case series and reviews), most of which are published in cardiology/internal medicine/emergency medicine journals. In allergologic literature, heart involvement during anaphylactic reactions is well documented, but Kounis syndrome is hardly mentioned. Single case reports and small case series of angina triggered by allergic reactions have been reported for many years, and involvement of histamine and others mast cell mediators in the pathogenesis of coronary spasm has long been hypothesized, but the existence of an allergic acute coronary syndrome (ACS) is still questioned in the allergologic scientific community. Putative mec...
Type 2 Kounis syndrome in an allergic woman: An uncommon presentation of acute coronary syndrome
Journal of Cardiology Cases, 2013
Acute coronary syndromes secondary to allergy-induced coronary vasospasm are known as "Kounis syndrome." The main pathophysiological mechanism of coronary spasm in Kounis syndrome is the release of inflammatory mediators during a hypersensitivity reaction triggered by food, insect bites, or drugs. Here, we report a case of an acute coronary syndrome secondary to allergic reaction following levofloxacin administration in a 68-year-old female without a prior history of coronary artery disease. Our patient's coronary angiography revealed moderate lesions in the coronary vasculature and she was diagnosed as having a type II variant Kounis syndrome. Type II variant includes patients in whom the acute release of inflammatory mediators due to mast cell degranulation such as histamine, serotonin, and leukotrienes can induce either coronary artery spasm with normal cardiac enzymes and troponins or plaque erosion or rupture manifesting as acute myocardial infarction. According to our knowledge, this is the first case report of Kounis syndrome attributed to levofloxacin administration.
An Atypical Presentation of Allergic Myocardial İnfarction
Acute coronary syndromes secondary to hypersensitivity reactions related with allergic factors are defined as Kounis syndrome. Doxycycline is an antibiotic commonly used in clinical practice. In this report, we described an atypical presentation of Kounis syndrome in a patient who was admitted to the emergency service complaining of chest pain, generalized rash and fever. She was taking doxycycline for 3 days because of urinary tract infection. Non specific ST-T changes were seen on electrocardiography, positive troponin levels were detected and global left ventricular wall motion abnormalities were defined by echocardiography. The patient had no conventional risk factor for acute coronary syndrome. Normal coronary angiography results, improved left ventricular functions and symptoms by antihistaminic and steroid treatments were consistent with Kounis syndrome. All patients admitted with the concurrence of chest pain and allergic symptoms should be asked about exposure to allergens.
The Israel Medical Association journal : IMAJ, 2013
Kounis syndrome is a contemporary occurrence of an allergic reaction and myocardial ischemia. Gadoterate meglumin is a contrast agent commonly used for magnetic resonance imaging with sporadically reported side effects, including severe allergic reactions. In our case, a 46-year-old patient with known multiple medical allergies, well regulated diabetes and no other coronary disease risk factors developed anaphylactic shock and Kounis syndrome following gadoterate meglumine application. There was a ST segment depression and elevation of cardioselective markers, but coronarography revealed smooth epicardial arteries without hemodinamically significant stenoses. We stress the importance of recognizing this rare clinical entity, diversity of causal allergens and also potential role of allergic mediators blockage in treating acute coronary syndrome.
JA Clinical Reports, 2019
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.