Kounis Syndrome Secondary to Wasp Sting

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Kounis Syndrome
(a) Right coronary angiography documenting coronary spasms at the proximal tract. (b) Angiography performed after intracoronary administration of isosorbide dinitrate documenting coronary spasm resolution.
  • Systemic anaphylaxis is a common and the most dramatic clinical presentation of allergy.
  • It often presents with cardiac and peripheral vascular symptoms, representing a medical emergency.
  • Mediators released during anaphylaxis can directly damage the myocardiam, leading to ischemia. This condition is known as Kounis syndrome.

This article describes the case of a 62-year-old male patient with Kounis syndrome that presented secondary to an allergic sensitisation. The patient presented to the emergency department with complaints of chest pain and acute urticaria after he was sting by a wasp on the right shoulder. He had no cardiovascular history or any history of allergies.

On examination, the patient’s blood pressure was 90/60 and heart rate 100 b/m. There were no signs of hemodynamic instability. Doctors advised an ECG which showed an elevated ST-T. However, the echocardiogram taken on admission showed normal cavity geometries with mild depression of the left ventricular function with 50% ejection fraction. In addition, akinesia of the lower wall was also evident. Lab work showed an elevated myoglobin, Ck-MB and troponin with presence of basophilia and eosinophilia. ASA

Doctors prescribes the patient ASA 250 mg and sodium heparin 5000 IU/e.v, oral ticagrelor and methylprednisolone for treatment of coronary syndrome and urticaria. The patient’s coronary angiography showed significant stenosis of the right proximal coronary artery because of coronary spasm. The stenosis resolved rapidly with administration of isosorbide dinitrate with normalisation of the altered ECG and remission of angina.

The patient was discharged on the third day with a referral to the allergy unit. Skin tests and specific IgE revealed sensitisation to wasp venom. Doctors administered immunotherapy for wasp venom.

References

Kounis Syndrome as First Manifestation of Allergic Sensitization https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614985/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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