Contrast Media Induced Kounis Syndrome: A Case Report

Abstract

Kounis syndrome is a rare anaphylactic reaction leading to coronary spasm, acute plaque rupture, or intrastent stenosis. Many types of medicine or environmental factors can potentially trigger Kounis syndrome by mast cell allergic reactions. In severe Kounis syndrome, reduced blood pressure or cardiac arrest may be accompanying symptoms. The treatment strategy for Kounis syndrome is usually difficult due to both cardiac dysfunction and allergic reactions. The delay to intervention to break the vicious circle may cause catastrophic complications. Therefore, early diagnosis is critical for physicians to outline detailed etiology for prevention and treat the cardiac and allergic symptoms in a timely manner. Here, we describe a case presenting rare severe Kounis syndrome with cardiac arrest which occurred after the administration of a contrast media.

Stroke in a patient of anaphylaxis—a case report and brief review

“…There are case reports in the literature on contrast medium hypersensitivity causing Kounis syndrome (KS) [ 8 , 9 ]. There are three variants of Kounis syndrome—vasospastic allergic angina, allergic myocardial infarction due to plaque rupture, and stent thrombosis with occluding thrombus infiltrated by eosinophils and mast cells [ 4 ].…”

Epirubicin-induced Kounis syndrome

“…Antibiotic and insect bites represent the most common triggers (27.4% and 23.4% respectively) [6]. Moreover, carboplatin [10], contrast media [11], isotretinoin [12], latex [13], and cobra bites [14] have also been identified as offenders. Therefore, an in-depth patient clinical history is mandatory for diagnosing Kounis syndrome.…”

Case Report: A case of Kounis syndrome induced by iodine contrast agent during coronary angiography

“…Given these circumstances, glucagon, not adrenaline, should be the first-line therapy for treating allergic reactions in KS patients ( 10 ). Thus, adrenaline should only be administered in cases of severe allergic reactions, keeping in mind that adequate fluid resuscitation and oxygen therapy are crucial treatments for KS ( 19 ). The use of vasopressors and vasodilators to relieve coronary spasm is also contradictory in hypotensive patients.…”