Kounis syndrome uncovers severe coronary disease: an unusual case of acute coronary syndrome secondary to allergic coronary vasospasm. Issue 12 (23rd December 2019)

• Record Type: Journal Article
• Authors: Conti, Luca; Gatt, Kelly; Zammit, Christopher; Cassar, Karen
• Is Part Of: BMJ case reports. Volume 12:Issue 12(2019)
• Publication Date: 2019-12-23
• Subjects: ischaemic heart disease -- interventional cardiology -- immunology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-232472
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : Acute coronary syndrome occurring during the course of a type I hypersensitivity reaction constitutes Kounis syndrome. We report a case of a 64-year-old man who presented with a non-ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and constitutional symptoms for several days prior to presentation. Blood investigations revealed moderate eosinophilia and elevated IgE levels. A cardiac MRI showed generalised oedema with a subtle wall motion abnormality in basal inferior/inferolateral wall, and subendocardial high signal on late gadolinium enhancement suggesting a localised myocardial infarction. A coronary angiogram then revealed triple vessel disease. A diagnosis of Kounis syndrome was made. Within days of starting appropriate treatment, the patient's eosinophil count returned to normal with improvement of clinical picture.