A Case of Kounis Syndrome Presenting as Coronary Artery Spasm Associated with Acetaminophen Infusion

Patient: Male, 38-year-old Final Diagnosis: Myocardial Infarction Symptoms: Chest discomfort • dyspnea • hypotension Medication: — Clinical Procedure: — Specialty: Allergology • Cardiology OBJECTIVE: Unusual clinical course BACKGROUND: Kounis syndrome is a hypersensitive coronary disorder triggered by drugs, food, and environmental factors. A 38-year-old male patient with acetaminophen-induced type 1 Kounis syndrome is described. The purpose of this paper is to show that Kounis syndrome is a serious condition that may be linked to a common medication and that it should be recognized earlier in clinical practice. CASE REPORT: We report a case of a 38-year-old male patient with chest discomfort, dyspnea, and hypotension following a paracetamol continuous infusion, as well as ST elevation on numerous leads during the episode. The diagnosis of drug-induced Kounis syndrome was made when the patient no longer had angina and the EKG returned to normal after the infusion was discontinued; the coronary angiography also showed no remarkable stenosis. CONCLUSIONS: Kounis syndrome is a hypersensitive coronary disease that involves eosinophil and/or mast cell infiltrated coronary stent thrombosis, vasospastic angina, and allergic myocardial infarction. Although acetaminophen is widely used, acetaminophen-induced Kounis syndrome is uncommon and seldom documented. The necessity of detecting the distinct appearance earlier to give more suitable therapy is highlighted in this report.