Vancomycin-induced coronary artery spasm: a case of Kounis syndrome

Abstract

Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.

Keywords: allergy, asthma; cardiovascular system; drug interactions; ischaemic heart disease; unwanted effects / adverse reactions.

Figure 1

ECG displaying normal sinus rhythm with an acute inferior-lateral myocardial ischaemia pattern, ST elevation in leads II, III and aVF with reciprocal minimal changes in the precordial leads.

Figure 2

ECG taken 4 min after initial ECG showing normalisation.