Abstract
Kounis syndrome (KS) occurs when acute coronary syndrome (ACS) is triggered by conditions associated with mast cell activation, such as allergic, hypersensitive, anaphylactic, or anaphylactoid insults. This case report shows KS after administration of gabexate mesilate (GM). A 72 y/o woman with a past medical history of chronic alcoholic pancreatitis presented with epigastric pain and was diagnosed with acute on chronic pancreatitis. After plain abdominal computed tomography, ulinastatin and intravenous GM were administered. Eight minutes later, however, she acutely developed shortness of breath, wheezing, facial flushing, and decreased level of consciousness. She went into shock, and electrocardiogram showed significant ST elevation in the inferior leads. Given her anaphylactic shock, two doses of intravenous epinephrine 0.1mg were given. Sublingual nitroglycerin was also administered given the left ventricular systolic motion abnormality on echocardiogram. Coronary angiography, however, showed no significant stenosis, thereby leading to a diagnosis of vasospastic angina. The patient eventually recovered and was discharged after two weeks. In patients such as the above, ACS is induced when chemical mediators are released from mast cells during allergic reactions. During treatment of patients with allergic reactions, therefore, the concurrence of ACS should be considered.
