Kounis Syndrome: A Paradoxal Non-ST Elevation Myocardial Infarction Case After Triamcinolone Treatment For Dermatitis [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. Ahead of Print: TKDA-58827 | DOI: 10.5543/tkda.2017.58827

Kounis Syndrome: A Paradoxal Non-ST Elevation Myocardial Infarction Case After Triamcinolone Treatment For Dermatitis

Mücahid Yılmaz1, Hasan Korkmaz2
1Elazığ Research And Education Hospital, Clinic Of Cardiology, Elazığ
2Department Of Cardiology, Fırat University Medicine Faculty, Elazığ, Turkey

SUMMARY


BACKGROUND
Kounis syndrome is defined as the development of the clinic of acute coronary syndrome in conditions such as allergy, hypersensitivity, anaphylaxis, or anaphylactic reactions due to the activation of inflammatory cells. Corticosteroids that are used in the treatment of many inflammatory conditions may paradoxically cause allergic reactions and even anaphylaxis.
CASE
This article presents a 52-year-old female patient that had a non-ST elevation myocardial infarction after triamcinolone use that was relieved by antihistaminic treatment. The patient who was diagnosed with dermatitis in an external center and injected with 40 mg/ml (iv) of triamcinolone acetonide developed chest pain 15 minutes after the first dose of treatment. Despite the normal physical examination and ECHO, the laboratory tests revealed troponin positivity and on ECG inferolateral ST depression was present. On the coronary angiography performed in the case whose ECG findings and clinic resolved completely after starting conservative anti-ischemic treatment and delivering antihistaminic treatment (pheniramine maleate 45.5 mg/2ml, Avil amp) (iv) the coronary arteries were evaluated as normal.
RESULT: The heart, and in particular the coronary arteries are among the organs that receive the most damage during hypersensitivity reactions and anaphylaxis. Although the Kounis syndrome is not a rare condition, it is reported that a little number of cases are seen in clinical practice. The failure to recognize Kounis syndrome due to inadequately defined cases may lead to unwanted medical results. To make a rapid and accurate diagnosis, the Kounis syndrome should be kept in mind.

Keywords: Kounis Syndrome, Hypersensitivity, Non-St Elevation Myocardial Infarction

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Corresponding Author: Mücahid Yılmaz, Türkiye
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