Bee Sting–Associated Kounis Syndrome Presenting as Myocardial Infarction: A Case Report and Systematic Review With Age-Based Analysis

Kounis syndrome (KS) is an uncommon acute coronary syndrome triggered by allergic or hypersensitivity reactions. Bee stings are a recognized precipitant, although the available evidence is largely limited to case reports and small case series. We present a 44-year-old man with probable bee sting–associated KS and systematically review published cases, including an exploratory age-based comparison using ≤45 years as the cutoff for myocardial infarction in younger individuals. PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scopus were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. A total of 47 patients were included, comprising 46 previously reported cases and our index case. The mean age was 55.7±13.0 years, and 39/47 patients (83.0%) were male. Symptoms developed within 30 minutes in 29/47 patients (61.7%), and chest pain occurred in 41/47 (87.2%). Type II KS predominated (29/43, 67.4%), while ST-segment elevation myocardial infarction (STEMI) occurred in 37/47 patients (78.7%), and revascularization was performed in 27/47 (57.4%). Cardiogenic shock, cardiac arrest, and rhythm or conduction disturbances occurred in 11/46 (23.9%), 5/46 (10.9%), and 7/46 patients (15.2%), respectively. Recovery at the last reported assessment was documented in 45/46 patients (97.8%), with no reported deaths. No follow-up data were available after the index patient left the hospital against medical advice approximately five hours after presentation. Thirteen patients (27.7%) were aged ≤45 years; age-stratified descriptive analyses did not reveal clear differences in most clinical characteristics; however, interpretation was limited by the small number of younger patients. Bee sting–associated KS may cause severe acute coronary presentations, including in younger individuals. Given the case-based and heterogeneous nature of the evidence, these findings should be interpreted cautiously and confirmed in systematically collected cohorts.

Keywords: Bee sting, Kounis syndrome, myocardial infarction.