The Deadly Duo-A Combination of Allergy and Acute Coronary Syndrome A Case of Kounis Syndrome Type 1.
Keywords:Allergic dermatitis,Kounis syndrome,Mast cells, Myocardial Infarction, allergic acute coronary syndrome.
Kounis syndromewas first described by Kounis and Zavras in 1991, as the concurrent occurrence of
acute coronary events with an allergic or a hypersensitivity response. Mast cell activation and release of
inflammatory mediators have shown to induce coronary spasm, plaque erosion and even stent thrombosis.
A 41 years old male, smoker was admitted with chest discomfort and features suggestive of myocardial
infarction. His ECG showed ST elevation and T inversion in I, aVL. High sensitive troponin I was elevated
and echocardiogram was normal. Four days ago, he had a history of redness and itching all over the body
and was treated for allergic dermatitis. He had a family history of urticaria also. Coronary angiogram
revealed no major flow limiting coronary artery disease. Kounis syndrome type 1 was diagnosed and he was
discharged on oral steroids and cardiac drugs. We always have to think of Kounis syndrome when treating
a young patient with allergy or anaphylaxis and concurrent acute coronary syndrome. Prompt recognition is
important as treatment is significantly different.
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