Kounis Syndrome Associated With Takotsubo Syndrome in an Adolescent With Peutz-Jeghers Syndrome

Abstract

We describe the case of a 15-year-old female patient with Peutz-Jeghers syndrome who presented with vomiting and abdominal pain secondary to ileoileal invagination. Initial analgesic treatment was not effective, and subsequent tramadol infusion resulted in clinical manifestations compatible with Kounis and Takotsubo syndromes. However, the patient had an excellent recovery. ( Level of Difficulty: Advanced. )

Exploring Variations in Etiology and Clinical Presentations of Kounis Syndrome Across Pediatric and Adult Populations: A Comprehensive Review

“…In the adult case reports, antibiotics such as vancomycin, cephalosporins, amoxicillin and clavulanic acid, clarithromycin, sulbactam-ampicillin, gemifloxacin, and penicillin were among the common antibiotics that lead to Kounis syndrome [7]. Atropine, epinephrine, midazolam, rocuronium, and tramadol were also reported as other drugs that led to Kounis syndrome in the pediatric case reports [10][11][12][13][14]. Across the 330 case reports that we finalized on Kounis syndrome in the adult population, a variety of drugs were the causative agents of Kounis syndrome, including NSAIDs, immunosuppressants, neuromuscular blocking agents, antipsychotics, and inhaled anesthetics (see Table 2).…”

“…In addition to the common symptoms of acute coronary syndrome, some patients also present with urticaria. While reviewing the literature, we noted that most adult case reports reported urticaria; likewise, in pediatric case reports, 45.0% presented with rash or urticaria [ 10 , 14 , 16 , 19 , 67 , 68 ]. Typical angina was the most common type of presenting angina for Kounis syndrome in both adult and pediatric case reports.…”

“…Loss of consciousness was present in one pediatric patient in the literature [ 11 ]. Additionally, three out of the 20 case reports in the pediatric age group developed pulmonary edema at the time of presentation [ 13 , 14 , 69 , 70 ]. Other presentations in the adult case reports include seizures, periorbital edema, kidney failure, cardiogenic shock, ventricular fibrillation, and cardiac arrest [ 71 - 82 ].…”

“…50% of patients in the pediatric case reports related to Kounis syndrome presented with EF>50% [ 6 - 8 , 10 , 13 , 67 - 69 , 83 , 91 ]. Despite some pediatric patients presenting with EF<50%, most patients had EF>50% at discharge [ 11 - 12 , 14 , 16 - 17 ]. Hypokinesia was also a common finding on echocardiography in the pediatric population [ 6 , 9 , 19 , 68 ].…”