Kounis syndrome presenting as inferior, posterior and lateral wall myocardial infarction with urticaria, angioedema and recanalized coronaries: A case report

Abstract

Background: Kounis syndrome is an underrecognized clinical entity characterized by the concurrence of acute coronary syndrome (ACS) with hypersensitivity reactions. We report a 41-year-old female with newly diagnosed type 2 diabetes mellitus who presented with a prodrome of generalized pruritus, fever, and arthralgia, followed by acute chest pain. Electrocardiogram revealed inferior, posterior, and lateral wall myocardial infarction. Coronary angiography showed recanalized coronaries without significant obstruction. The patient also developed urticaria with angioedema and swelling. Laboratory findings demonstrated leukocytosis with normal IgE and negative autoimmune markers. A diagnosis of Kounis syndrome was made. This case highlights the importance of recognizing allergy as a provoker of myocardial ischemia even in the absence of classical immunological abnormalities.