Abstract
A 66-year-old man with no allergic history underwent primary percutaneous coronary intervention in the left anterior artery for anterior myocardial infarction with implantation of a drug-eluting stent 3 months ago. Here he underwent a contrast medium infusion for follow-up of vertebral artery dissection by cranial CT angiography. During the infusion, generalized rash, decreased blood pressure, and loss of consciousness occurred. His symptoms of anaphylaxis improved after an intramuscular injection of 0.3 mg of adrenalin, but he complained of typical chest pain. An electrocardiogram revealed ST elevation in the anterior leads for which we diagnosed Kounis syndrome. Coronary angiography revealed occlusion of the stent for which direct stenting of the left anterior artery was successfully performed. Contrast medium must be administered in the examination and treatment of Kounis syndrome, even in cases triggered by contrast medium. In this case, the stent was placed under steroid administration. The patient's postoperative course was good without recurrence of the anaphylaxis. In conclusion, during the treatment of patients with allergic reactions, the possibility of concurrent acute coronary syndrome should be considered. Coronary angiography and percutaneous coronary intervention must be performed for the assessment and treatment of Kounis syndrome, even in cases triggered by contrast medium.
