Letter to the Editor
Drug eluting stent-induced Kounis syndrome

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Abstract

Kounis syndrome is the concurrence of acute coronary syndromes with allergic conditions like anaphylaxis or anaphylactoid reactions. Cases of hypersensitivity to drugs-eluting-stent (DES) components able to cause serious clinical sequelae, like stent thrombosis have been reported recently. We report a case of a 50-year-old male, allergic to larvae of fly carvaria, who, after exposure to the allergen, developed an acute myocardial infarction due to stent thrombosis, despite optimal medical therapy. To our knowledge this is the first description of intra-stent thrombosis associated with Kounis syndrome. The clinical implications and physiopathology of this association are discussed.

Introduction

Kounis syndrome (KS) [1] is the concurrence of acute coronary syndrome with hypersensitivity and anaphylactic or anaphylactoid reactions. This syndrome was firstly described in 1991 [2], but only 1998 Braunwald [3] noted that vaso spastic angina can be induced by “allergic reactions with mediators such as histamine or leukotrienes”. Moreover, hypersensitivity reactions to components of DES which ,via intracoronary mast cell activation, can induce destabilization of the plaque with consequent inflammation and thrombosis have been reported [4], [5]. We report a case of acute myocardial infarction, due to stent thrombosis following an acute allergic reaction.

Section snippets

Case report

A 50-year-old male was referred by his general practitioner for chest pain which was started two hours before presentation. He had a family history of coronary heart disease, hypercholesterolemia and diabetes; was also allergic to larvae of fly carvaria. During examination the pain had been resolved; the blood pressure level was 125/75 mmHg, pulse rate was 78/min and regular; findings on cardiovascular, respiratory, abdominal and neurological examination were normal. ECG and transthoracic

Discussion

KS [1] is the concurrence of acute coronary syndromes (ACS) with conditions associated with mast cells activation.

The main mechanisms are coronary artery spasm and/or atheroma erosion or rupture with consequent thrombosis. These are also at the base of the classification of KS in two variants [6]: Type I (coronary spasm) in patients with normal coronaries that represent a manifestation of endothelial dysfunction and Type II (coronary thrombosis) in patient with quiescent atherosclerosis. In the

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [14].

References (14)

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