Eosinophilia and Coronary Artery Vasospasm

Wong, CW; Luis, Sushil Allen; Zeng, Irene; Stewart, Ralph

doi:10.1016/j.hlc.2008.06.003

Cited by 50 publications

(37 citation statements)

References 35 publications

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“…Clinical reports have shown that the absolute number of eosinophils and the eosinophil/leukocyte ratio, in the peripheral blood, are significantly elevated in patients with coronary artery disease [92]. Coronary vasospasm associated with eosinophilia responds poorly to conventional vasodilator treatment and while the risk of recurrent coronary events is high, the majority of patients respond to treatment which suppresses eosinophilia such as corticosteroids [93]. Subcutaneous allergen-specific immunotherapy used for treatment of IgE-mediated allergic diseases was found to be associated with lower risk of acute myocardial infarction and autoimmune disease [94].…”

Section: Innate Release Of Pro-inflammatory Molecules: Common Pathwaymentioning

confidence: 99%

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Kounis¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

310

421

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Kounis syndrome has been established as a hypersensitivity coronary disorder induced by various conditions, drugs, environmental exposures, foods and coronary stents. Allergic, hypersensitivity, anaphylactic and anaphylactoid reactions are associated with this syndrome. Vasospastic allergic angina, allergic myocardial infarction and stent thrombosis with occluding thrombus infiltrated by eosinophils and/or mast cells constitute are the three reported, so far, variants of this syndrome. Apart from coronary arteries, it affects the cerebral and mesenteric arteries. Its manifestations are broadening and its etiology is continuously increasing. Kounis syndrome is a ubiquitous disease which represents a magnificent natural paradigm and nature's own experiment in a final trigger pathway implicated in cases of coronary artery spasm and plaque rupture. Kounis syndrome seems to be not a rare disease but an infrequently diagnosed clinical entity which has revealed that the same mediators released from the same inflammatory cells are also present and in acute coronary events of non allergic etiology. These cells are not only present in the culprit region before plaque erosion or rupture but they release their contents just before an actual coronary event. Therefore, awareness of etiology, epidemiology, pathogenesis and clinical manifestations seems to be important for its prognosis, diagnosis, treatment, prevention.

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Section: Innate Release Of Pro-inflammatory Molecules: Common Pathwaymentioning

confidence: 99%

Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management

Kounis¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

310

421

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“…The primary eosinophilic syndrome has an estimated cardiac manifestation rate of up to 50% with a pathological process comprising acute necrosis, thrombosis and fibrosis: in other words, Loeffler's endomyocarditis 23. Individual case reports demonstrate occurrence of primary cardiac arrest in this syndrome with or without evidence of ischaemia 21 24 25. Moreover, a whole disease subset of coronary vasospasm, manifesting as angina or myocardial infarction, secondary to hypersensitivity reactions is recognised by the term Kounis syndrome 26.…”

Section: Discussionmentioning

confidence: 99%

Enigma: infection or allergy? Vancomycin-induced DRESS syndrome with dialysis-dependent renal failure and cardiac arrest

Webb

Al‐Mohammad

2016

BMJ Case Reports

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A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism. Subsequently, he developed a severe allergic reaction to prolonged empirical vancomycin therapy. This manifested as fever, widespread maculopapular rash and severe progressive acute kidney injury ultimately requiring dialysis. In the context of eosinophilia, this was determined to be drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Deciphering this complication as allergy in the context of severe infection required extreme caution due to the polarity of treatment with immunosuppression. Ultimately, this was used, with improvement of renal function, resolution of symptoms and absence of recurrence of infection. In summary, we present a case of vancomycin-related DRESS syndrome leading to dialysis-which is unique in the literature-complicating the treatment of culture-negative infective endocarditis.

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“…He was begun on montelukast and was doing well. He presented a series from New Zealand of 15 patients with eosinophilia and coronary artery spasm (2). Four of the patients were noted to have asthma.…”

Section: March 2018 Arizona Thoracic Society Notesmentioning

confidence: 99%