de Gregorio C, Granata L, Raspanti D, Giannino F, Cimino C, Koniari I, Andò G, Kounis NG. Cephalosporin triggered Kounis syndrome: Pathophysiological and clinical insights.
Int J Cardiol 2025;
431:133249. [PMID:
40220960 DOI:
10.1016/j.ijcard.2025.133249]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2025] [Revised: 04/03/2025] [Accepted: 04/07/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND
Acute coronary syndrome triggered by hypersensitivity to various natural, chemical, or pharmaceutical allergens is known as Kounis syndrome. Kounis syndrome is classified in three subtypes based on its pathophysiological mechanism and outcome. Among pharmaceuticals, cephalosporins are frequently implicated in allergic illnesses, with ceftriaxone being one of the most frequently reported causes. Based on literature reports and our own experience, we focused on the main clinical features regarding ceftriaxone triggered KS (CTKS).
METHODS
Medical records from all CTKS cases, as published by the end of December 2024, were retrieved and analyzed, including a patient admitted to our hospital after inadvertent twice ceftriaxone administration.
RESULTS
Clinical findings from 10 CTKS patients, mean aged 61 ± 18 (range 24-85) years, 5 males, were studied. Type-I KS (coronary vasospasm) was found in 8 cases (80 %), whereas 2 more patients showed a type-II variant (atheromatous plaque thrombosis), with the right artery as the most involved coronary vessel. Apart from transient hemodynamic instability in 2 patients on admission, everyone was discharged in a good clinical condition.
CONCLUSIONS
CTKS is a rare, but likely underrecognized, clinical condition that may occur regardless of gender, age, history of allergy or preexisting coronary artery disease. The predominant type-I variant indicates a transient coronary asospasm (and/or microcirculatory impairment) as the most likely pathogenic mechanism. Key pathophysiological, clinical, and prognostic aspects are discussed.
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