Paracetamol

Abstract

Type 1 Kounis-syndrome: case reportA 38-year-old man developed type 1 Kounis syndrome during treatment with paracetamol for infectious diarrhoea [dosage and exact time to reaction onset not stated].The man, who consumed raw foods, presented to a rural hospital with a 3-days history of lightheadedness, stomachache, diarrhoea and blood stains. He was admitted with a diagnosis of infectious diarrhoea. His medical history included heavy smoking, diabetes and hyperlipidaemia. Upon admission, he started receiving treatment with paracetamol infusion, and shortly thereafter, he experienced hypotension, chest discomfort and dyspnoea. Electrocardiogram revealed posterior and anterolateral ST elevation and depressed ST segments in leads aVR, V1, V2, V3, V3R, V4R with no q waves. His hs-Troponin T level was noted to be elevated. Other tests were unremarkable. A diagnosis of acute myocardial infarction was made, and he was referred to another hospital. A repeat electrocardiogram was performed, 6h after the angina attack, which showed no ST-T alterations, sinus rhythm with no q waves at any of the leads. The blood concentrations of D-dimer and hs-Troponin T were noted to be increased. The diagnosis of type 1 Kounis syndrome was confirmed, and he was referred to other cardiology centre. On arrival to hospital (12h after the angina attack) his EKG was observed to be negative, along with normal transthoracic echocardiography. He was admitted for planned coronary angiography. The left ventricular function was 71%, and no pericardial effusion was observed. The blood IgE concentration was found to be increased. Coronary angiography findings showed no stenosis, right coronary dominance and no wall motion abnormalities in left ventriculography. He was then discharged with an uneventful hospital course.