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Case Reports
. 2021 Nov 17;4(3):337-339.
doi: 10.1016/j.cjco.2021.11.003. eCollection 2022 Mar.

Kounis Syndrome: A Case of Vancomycin-Associated Coronary Artery Vasospasm Resulting in Myocardial Infarction

Luke R Gagnon  1   2 , Yiming Huang  1   2 , Robert Kay  1   2 , Bibiana Cujec  1   2
Affiliations
Case Reports

Kounis Syndrome: A Case of Vancomycin-Associated Coronary Artery Vasospasm Resulting in Myocardial Infarction

Luke R Gagnon et al. CJC Open. .

Abstract
in English, French

We describe a case of Kounis syndrome, an allergic reaction causing coronary artery vasospasm, triggered by a vancomycin infusion, in a healthy 32-year-old man. The patient initially presented with an inguinal abscess requiring intravenous vancomycin. During his third infusion, he developed typical chest pain that resolved with cessation of the infusion. Troponin was elevated, and electrocardiogram showed ST elevation, prompting emergent cardiac catheterization that demonstrated normal coronary arteries. The cause of the myocardial infarction was consistent with Kounis syndrome. Diagnosis of Kounis syndrome is important, as prompt cessation of the offending agent is a priority to reduce further cardiac injury.

Nous décrivons un cas de syndrome de Kounis, une réaction allergique causant un angiospasme coronarien, déclenchée par une perfusion de vancomycine, chez un homme en bonne santé de 32 ans. Le patient a d’abord présenté un abcès inguinal nécessitant l’administration intraveineuse de vancomycine. Au cours de sa troisième perfusion, il a ressenti une douleur type à la poitrine, qui s’est résorbée après l’interruption de la perfusion. Le taux de troponine était élevé, et l’électrocardiogramme montrait une élévation du segment ST, ce qui a mené à un cathétérisme cardiaque d’urgence qui a révélé des artères coronaires normales. La cause de l’infarctus du myocarde cadrait avec le syndrome de Kounis. Le diagnostic de ce syndrome est important, car l’interruption rapide de l’administration de l’agent concerné est prioritaire pour limiter les lésions cardiaques.

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Figures

Figure 1
Figure 1
(A) Initial electrocardiogram (ECG) demonstrated 1 mm ST elevation in leads II, III, aVF without reciprocal changes. (B) ECG during repeat chest pain demonstrated 3 mm inferolateral ST elevation. (C) Left coronary artery angiogram. (D) Right coronary artery angiogram.
See this image and copyright information in PMC

References

    1. Kounis N.G. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med. 2016;54:1545–1559. - PubMed
    1. Picard F., Sayah N., Spagnoli V., Adjedj J., Varenne O. Vasospastic angina: a literature review of current evidence. Arch Cardiovasc Dis. 2019;112:44–55. - PubMed
    1. Martinez E., Sahni S., Cheema M.A., Iftikhar A. Vancomycin-induced coronary artery spasm: a case of Kounis syndrome. BMJ Case Rep. 2018;2018 bcr2017222846. - PMC - PubMed
    1. Leibee C., Getachew B., Ehmann M.R. Vancomycin-induced Kounis syndrome. Am J Emerg Med. 2019;37:1806. e1803-e1806. - PubMed
    1. Rybak M.J. The pharmacokinetic and pharmacodynamic properties of vancomycin. Clin Infect Dis. 2006;42(suppl 1):S35–S39. - PubMed

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