Kounis Syndrome – ABC CARDIOL

IJCS

Case Report

Allergy and Ischemia: A Case Report of Type II Kounis Syndrome

Rafael Viana et al. Miguel Carias Diogo Brás

Introduction

Kounis Syndrome (KS), also known as “allergic angina,” is a rare condition in which an allergic reaction triggers acute coronary events. Its mechanism involves mast cell degranulation, releasing inflammatory mediators such as histamine, cytokines, and proteases. These substances can induce coronary artery spasm, plaque rupture, or thrombus formation. KS is classified into three types: Type I (occurring in patients without coronary artery disease, CAD), Type II (in patients with pre-existing CAD), and Type III (associated with stent thrombosis). In this report, we present a case of Type II KS.

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ABC

Case Report

Kounis Syndrome Type II after Diclofenac Exposure: Unmasking a Link Between Drug Allergy and Acute Coronary Syndrome

Rafaella Avakian Mansur et al. Solange Desirée Avakian Antonio de Padua Mansur

Introduction

Kounis syndrome (KS), first identified in 1991 as “allergic angina,” marks a significant intersection between cardiology and allergology. It involves episodes of acute coronary syndrome (ACS), such as vasospasm, myocardial infarction, or stent thrombosis, occurring during allergic, anaphylactic, or hypersensitivity reactions. This syndrome demonstrates the direct impact of systemic inflammation on coronary vessels, primarily through mast cell activation and degranulation. Although it was first described more than 30 years ago, KS remains highly underdiagnosed and frequently overlooked, leading to delays in proper treatment. Its pathophysiology includes the release of various inflammatory mediators like histamine, leukotrienes, tryptase, chymase, and platelet-activating factor. These substances can cause coronary artery vasospasm, trigger plaque erosion or rupture in existing atheromatous plaques, and promote a prothrombotic environment, resulting in ACS.^, Systematic reviews of existing literature, mainly case reports and series, are beginning to clarify KS’s epidemiological and clinical features. A recent comprehensive review by Cahuapaza-Gutierrez et al. of 214 patients showed a male predominance (69.6%), with an average age of 54.4 years, and hypertension was the most common comorbidity (33.6%). The most frequent triggers are medications (38.3%), especially antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs), followed by insect stings (26.2%). KS is classified into three main types: type I (coronary spasm without pre-existing disease), type II (myocardial infarction with underlying coronary artery disease), and type III (stent thrombosis). A proposed “type IV” involves thrombosis of coronary artery bypass grafts. Recognizing this classification is crucial for clinicians, as treatment must address both the acute cardiac ischemia and the allergic reaction. This case report of typical type II KS triggered by diclofenac sodium aims to contribute to the growing body of evidence and underscore the importance of heightened clinical awareness.

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IJCS

Case Report

Kounis Syndrome: Case Report in Goiânia/BR

Marília Pereira et al. Gabriela Lima Vieitas Anna Ilona Hunkar Freitas Karoly Gyula Olivas Hunkar

Abstract

22-year-old male patient with no heart disease, who was given an ambulatory medication with analgesics due to an acute renal crisis. After the drug administration, the patient presented dyspnea, cyanosis, and hemoptysis. There was suspicion of anaphylactic shock, which was treated, but there was no improvement in the clinical condition. The patient was referred to the Intensive Care Unit, where tests were performed showing elevated cardiac enzymes and Immunoglobulin E and Computed Tomography of Thoracic revealed alveolar hemorrhage. He developed clinical worsening and died after sepsis. The final diagnosis was of kounis syndrome due to the hypersensitivity reaction to the analgesics introduced in the patient, generating an acute coronary syndrome (ACS). The purpose of this case report was to highlight a syndrome that is little reported because it is not part of the differential diagnosis routines of ACS, but it generates important complications.

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Allergy and Ischemia: A Case Report of Type II Kounis Syndrome

Introduction

Kounis Syndrome Type II after Diclofenac Exposure: Unmasking a Link Between Drug Allergy and Acute Coronary Syndrome

Introduction

Kounis Syndrome: Case Report in Goiânia/BR

Abstract

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