Recurrent Kounis Syndrome Due to Amoxicillin Induced Anaphylaxis: A Case Report

Abstract

Kounis syndrome is the occurrence of acute coronary syndrome during an allergic, anaphylactoid or anaphylactic reaction. It is thought to be due to the mast cells activation and degranulation. Patients can present with features of Acute coronary syndrome during or after a hypersensitivity reaction. Here we report a case of a 60-year-old gentleman presenting with fascial swelling, rash, shortness of breath associated with severe tightening left sided chest pain and dizziness which occurred 5 minutes after taking Amoxicillin. Serial ECGs taken showed dynamic ischemic changes with a rising Troponin I titer. He was subsequently managed for both the anaphylaxis and the non-ST elevation myocardial infarction. Subsequent history revealed that he had a similar episode following amoxicillin four years ago. This case report highlights the importance identifying Kounis syndrome as an important differential diagnosis amongst patients presenting with chest pain. This syndrome which can be easily diagnosed clinically if missed can lead to mismanagement of a relatively easily treatable cause of acute coronary syndrome.