2021 Volume 70 Issue 4 Pages 817-823
We experienced treating two cases of suspected Kounis syndrome with ST-segment elevation and electrocardiographic changes associated with anaphylactic shock. Case 1: A 70-year-old woman was transferred to a critical care center owing to anaphylactic shock immediately after using a contrast medium. At the time of admission, neither her consciousness level JCS I-3 nor blood pressure could be measured, and electrocardiography showed ST-segment elevation in leads II and III and aVF, and ST-segment depression in leads V1 to V5. Although ACS was suspected, no significant stenosis of the coronary arteries or ACS was observed. From the above, it is considered that the ST-segment elevation and depression in electrocardiography, which indicated anaphylactic shock, was caused by the contrast medium. Case 2: A 59-year-old man who took PL granules and Flomox after seeing a local doctor showed an anaphylactic shock, and electrocardiography showed ST elevation of leads II and III and aVf. Since acute coronary syndrome was also suspected, he was referred to our hospital. No significant stenosis was observed on coronary angiography, and the acetylcholine tolerance test showed negative results. In the lymphocyte transformation test, positive reactions to PL granules and Flomox were observed; thus, it was concluded that the electrocardiographic changes were due to anaphylactic shock. Kounis syndrome is a rare disease that is triggered by an allergic reaction and causes acute coronary syndrome. If a patient presents with a serious condition, the possibility of Kounis syndrome should be taken into consideration when conducting examinations, treatments, and observations.
