Abstract
Kounis syndrome encompasses acute coronary syndrome features associated with severe
vasospasm of the coronary artery. It is related to allergic anaphylactic reaction
triggered by the release of inflammatory cells and mediators. This entity, however,
is often not properly diagnosed. In this report, we aimed to discuss a case of Kounis
syndrome mimicking acute coronary syndrome. We presented a 58-year-old man with dyspnea,
chest pain, dizziness, and itchiness 30 minutes following sodium diclofenac ingestion.
His physical examination was remarkable for shock with hypoxia and features of anaphylactic
reaction. An urgent electrocardiogram was obtained, manifesting deep ST-segment depression
in anterolateral leads with ST elevation of aVR, which hinted a severe three-vessel
disease or left main disease. Allergic acute coronary syndrome was suspected. Thus,
the patient was managed with fluid resuscitation, epinephrine, and corticosteroid
injection along with acute coronary syndrome treatment algorithm with a favorable
clinical response. One-hour serial ECG showed complete resolution of ST depression
with aVR normalization. This pointed to possible acute coronary spasm. No further
coronary intervention was performed, the patient was discharged after 2 days in good
condition and planned for further cardiac evaluation during follow-up. Kounis syndrome
is an intriguing process caused by the presence of two disease entities that must
be treated simultaneously. The difficulty in treating this condition stems from the
fact that treating one of both entities may aggravate the other. Thus, a comprehensive
approach and health education are strongly advised to ensure that this condition does
not reoccur in the future.
Keywords
Kounis syndrome - acute coronary syndrome - anaphylaxis reaction - case report
