Kounis syndrome induced by cefditoren pivoxil

Kounis Syndrome That Recurs in A Short Time Period: A Case Report

This case report is unique for the occurrence of a quickly recurring Kounis Syndrome (KS) due to re-exposure to the same agent. A 40-year-old male was brought to our ED with a diagnosis of non-ST-segment elevation myocardial infarction. He stated that he had taken one dose of amoxicillin-clavulanate 1,000 mg at 03.00 AM. After taking the drug, chest pain and vomiting began. ECG which was taken at the the rural hospital, revealed a normal sinus rhythm with no ischemic changes. The value of cardiac troponin I 0.34 ng/ml in the rural hospital. The patient was consultated to the cardiology clinic with a pre-diagnosis of KS. Percutaneous coronary intervention showed that coronary arteries were normal and no plaque formation was found. The patient, who was diagnosed with type I KS, left the hospital at his own request at 14:12 PM. The patient presented to our ED again at 22:30 PM with chest pain and shortness of breath after accidentally using the same allergenic drug ~eight hours after leaving our hospital. ECG showed > 0.5 cm ST-segment elevation in leads DII, DIII, and aVF. Quickly recurring KS was due to accidental reuse of the same agent may be more severe than the first occurrence.

Analysis of Clinical Features of Kounis Syndrome Induced by Cephalosporin

Background

Cephalosporins are an increasingly encountered cause of Kounis syndrome. The present study examined the clinical features of cephalosporin-induced Kounis syndrome and provided references for diagnosis, prevention, treatment, and prognosis.

Methods

We collected cephalosporin-induced Kounis syndrome case reports by searching Chinese and English databases from the establishment of the database to October 31, 2021.

Results

Twenty-five patients (17 males and eight females) were included, with a median age of 61 years (range 33–92). Cephalosporins were administered via oral, intravenous and intramuscular routes. All reactions occurred within 30 min, except in two patients. Fourteen patients experienced chest pain, 19 experienced hypotension, 16 had cutaneous reactions, 10 had respiratory symptoms, and seven had gastrointestinal symptoms. Thirteen patients had elevated troponin levels, and eight patients had elevated serum tryptase levels. The electrocardiogram showed ST-segment elevation in 13 patients, depression in four patients, and elevation and depression in six patients. Coronary angiography showed normal results in 12 patients and abnormal results in 13 patients. The skin prick test was positive for cephalosporin in three patients. Twenty-four of the 25 patients recovered after being given anti-allergic and acute coronary syndrome treatment, and there was one death.

Conclusions

Kounis syndrome is a serious adverse reaction to cephalosporin. Clinicians should consider Kounis syndrome in every patient receiving cephalosporin and presenting with acute chest pain or anaphylactic symptoms.

Vancomycin-induced coronary artery spasm: a case of Kounis syndrome

Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.