Case Report Type III Kounis Syndrome Secondary to Ciprofloxacin-Induced Hypersensitivity

Navarro-Navajas, Alberto; Casallas, Ingrid; Isaza, Daniel; Ortiz, Paola; Baracaldo-Santamaría, Daniela; Calderon-Ospina, Carlos-Alberto

doi:https://doi.org/10.3390/medicina58070855

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Case Report Type III Kounis Syndrome Secondary to Ciprofloxacin-Induced Hypersensitivity

https://repository.urosario.edu.co/handle/10336/46900
https://doi.org/10.3390/medicina58070855

Autores

Navarro-Navajas, Alberto

Casallas, Ingrid

Isaza, Daniel

Ortiz, Paola

Baracaldo-Santamaría, Daniela

Calderon-Ospina, Carlos-Alberto

Fecha

2022-05-27

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Resumen

El síndrome de Kounis (SK) es una condición poco frecuente caracterizada por la coexistencia de un síndrome coronario agudo con una reacción de hipersensibilidad, mediada por la activación de mastocitos y plaquetas. Puede manifestarse como vasoespasmo coronario, infarto agudo de miocardio o trombosis de stent, desencadenados por fármacos, vacunas, alimentos o picaduras de insectos. Es una patología potencialmente mortal que requiere reconocimiento y tratamiento oportunos. El caso describe a un paciente de 71 años con antecedentes de hipertensión arterial e infarto sin elevación del ST seis meses antes, tratado con angioplastia y colocación de stent en la arteria circunfleja. Tras ingerir ciprofloxacino para una infección urogenital, presentó prurito generalizado, edema lingual, disnea y dolor torácico. El electrocardiograma mostró elevación del ST en derivaciones II, III y aVF, y troponina positiva. La arteriografía coronaria reveló oclusión trombótica completa del stent en la arteria circunfleja, confirmando un infarto agudo de miocardio tipo 4b inferolateral secundario a un síndrome de Kounis tipo III inducido por ciprofloxacino. El caso resalta la relación entre las reacciones alérgicas y los eventos coronarios agudos, y subraya la importancia del diagnóstico y tratamiento tempranos de este síndrome potencialmente fatal.

Abstract

Kounis syndrome (KS) is a rare syndrome characterized by the co-occurrence of acute coronary syndromes in the setting of mast cell and platelet activation in response to hypersensitivity reactions. It can be manifested as coronary vasospasms, acute myocardial infarction, or stent throm bosis triggered by drugs, vaccines, foods, coronary stents, and insect bites. It is a life-threatening condition that needs to be adequately recognized for early diagnosis and appropriate treatment. In this case report, we present a 71-year-old patient with a history of arterial hypertension and non-ST elevation myocardial infarction six months earlier that was treated percutaneously with angioplasty plus stent implantation in the circumflex artery, who subsequently presented to the emergency department due to generalized itching associated with tongue swelling, dyspnea, and chest pain after ingestion of ciprofloxacin for the treatment of a urogenital infection. An electrocardiogram showed ST elevation in II, III, and aVF leads, and positive troponin; thus, a coronary arteriography was performed that showed complete thrombotic stent occlusion in the circumflex artery. Consequently, diagnosis of type 4b inferolateral acute myocardial infarction secondary to ciprofloxacin-triggered type III Kounis syndrome was made. The aim of this report is to understand the relationship between the allergic reaction to ciprofloxacin and the acute coronary syndrome, and to create awareness of the importance of early diagnosis and treatment of this potentially fatal syndrome.