Seorang penderita syok anafilaksis dengan allergic myocardial infarction (kounis syndrome)

I Putu Ary Wismayana; I Ketut Suardamana

doi:10.15562/ism.v12i3.1207

Seorang penderita syok anafilaksis dengan allergic myocardial infarction (kounis syndrome)

I Putu Ary Wismayana ,

I Ketut Suardamana ,

pdf |
DOI: https://doi.org/10.15562/ism.v12i3.1207 |
Published: 2021-12-30

Abstract

Background: Kounis syndrome (KS) is defined as the concurrence of acute coronary syndromes associated with mast-cell and platelet activation in the setting of allergic or anaphylactic insults. Prevalence of KS is considered rare, estimated 1.1% of hospitalized allergic reaction patient, with mortality rate 7%.

Case Report: Case of 39 years old male without history of coronary artery disease, having dyspnea, chest discomfort, and pruritus after eating skipjack tuna. 12 lead electrocardiogram showing ST depression segment on lead II, III, and aVF. Patient diagnose as Kounis syndrome variant type I. Treatment of Kounis Syndrome begins with cessation of the causative agent. After therapy using epinephrine and intravenous corticosteroid, clinical improvement was achieved, and ST segment depression on electrocardiogram resolved.

Conclusion: Kounis syndrome is a rare disorder which need careful assessment and swift management. The diagnosis confirmed with sign and symptoms of allergic along with disorder in cardiovascular system.

Latar Belakang: Kounis Syndrome (KS) didefinisikan sebagai sindrom koroner akut yang terjadi bersamaan dengan aktivasi sel mast dan trombosit dalam keadaan alergi atau anafilaksis. Prevalensi KS tergolong jarang, diperkirakan 1,1% dari pasien reaksi alergi yang dirawat di rumah sakit, dengan angka kematian 7%.

Laporan Kasus: Laki-laki 39 tahun tanpa riwayat penyakit jantung koroner, sesak nafas, rasa tidak nyaman di dada, dan pruritus setelah makan ikan cakalang. Elektrokardiogram 12 sadapan menunjukkan segmen depresi ST pada sadapan II, III, dan aVF. Diagnosis pasien sebagai sindrom Kounis varian tipe I. Pengobatan Sindrom Kounis dimulai dengan penghentian agen penyebab. Setelah terapi menggunakan epinefrin dan kortikosteroid intravena, perbaikan klinis dicapai serta depresi segmen ST pada elektrokardiogram teratasi.

Simpulan: Kounis syndrome adalah kelainan langka yang membutuhkan penilaian yang cermat dan penanganan yang cepat. Diagnosis ditegakkan dengan adanya tanda dan gejala alergi disertai gangguan pada sistem kardiovaskular.

References

Barrios JL, Gomez F, Perez N, Barrionuevo E, Dona I, Fernandez TD, dkk. Accurate of the diagnosis of allergy reactions at the Emergency Department. J Investig Allergol Clin Immuno. 2019;29(3):1–26.
Acker WW, Plasek JM, Blumenthal KG, Lai KH. Prevalence of food allergies and intolerances documented in electronic health records. J Allergy Clin Immunol. 2017;5:1–6.
Cervellin G, Schirosa F, Buonocore R, Nouvenne A, Borghi L, Meschi T, et al. Spring season birth is associated with higher emergency department admission for acute allergic reactions. Eur J Intern Med. 2015;11:1 - 5.
Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010; 2:18–23.
Kounis NG, Mazarakis A, Tsigkas, Giannopoulos S, Goudevenos J. Kounis syndrome: a new twist on an old disease. Future Cardiol. 2011;7(6):805–824.
Desai R, Parekh T, Patel U, Fong HK, Samani S, Patel C, dkk. Epidemiology of acute coronary syndrome co-existent with allergic/ hypersensitivity/ anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis, International Journal of Cardiology. 2019;6:1 -16.
Kounis NG. Kounis syndrome : an update on epidemiology , pathogenesis , diagnosis and therapeutic management. Clin Chem Lab Med. 2016;54(10):1545–1559.
Abdelghany M, Subedi R, Shah S, Kozman H. Kounis syndrome : A review article on epidemiology , diagnostic findings , management and complications of allergic acute coronary syndrome. Int J Cardiol. 2017;232:1–4.
Wilson BJ, Musto RJ, Ghali WA. A Case of Histamine Fish Poisoning in a Young Atopic Woman. J Gen Intern Med. 2012;27(7):878–881.
Kounis NG, Patsouras N, Grapsas N, Hahalis G. Histamine induced coronary artery spasm , fish consumption and Kounis syndrome. Int J Cardiol. 2015;193:39–41.
Wickman M. When allergies complicate allergies. Allergy. 2005;60(12):14–18.
Kounis NG, Tsigkas G, Almpanis G, Kouni SN, Kounis GN, Mazarakis A. Anaphylaxis-induced hyperfibrinogenolysis and the risk of Kounis syndrome: the dual action of tryptase. Am J Emerg Med. 2011;29(9):1229–1230.
McGrath SC, Grantdorffer I, Lendeckel U, Ebert MP, Rocken C. Angiotensin II-generating enzymes , angiotensin-converting enzyme (ACE) and mast cell chymase ( CMA1 ), in gastric inflammation may be regulated by H . pylori and associated cytokines. Pathology. 2009;4:419–427.
Riccioni G, Zanasi A, Vitulano N, Mancini B, Orazio ND. Leukotrienes in Atherosclerosis : New Target Insights and Future Therapy Perspectives. Mediator of Inflamation. 2009;2009:1-6.
Cui S, Shibamoto T, Liu W, Takano H, Kurata Y. Effects of platelet-activating factor , thromboxane A2 and leukotriene D4 on isolated perfused rat liver. Prostaglandins & other Lipid Mediators. 2006;80:35–45.
Sciatti E, Vizzardi E, Cani DS, Castiello A, Bonadei I, Savoldi D, et al. Kounis syndrome, a disease to know: Case report and review of the literature. Monaldi Archives for Chest Disease. 2018;88:9–14.
Kounis NG, Koniari I, Soufras GD, Tsigkas G, Chourdakis E, Despotopoulos S, et al. Kounis syndrome : An additional etiologic factor of myocardial infarction with non-obstructive coronary arteries. Cardiology Journal. 2018;25(5):648–649.
Kounis NG. Serum tryptase levels and Kounis syndrome. International Journal of Cardiology. 2007;114:407–408.
Omri M, Kraiem H, Mejri O, Naija M, Chebili N. Management of Kounis syndrome : two case reports. Journal of Medical Case Reports. 2017;11:145–151.
Lippi G, Buonocore R, Schirosa F, Cervellin G. Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions . A case – control study. Int J Cardiol. 2015;194:68–69.
Goto K, Kasama S, Sato M, Kurabayashi M. Myocardial scintigraphic evidence of Kounis syndrome : what is the aetiology of acute coronary syndrome. European Heart Journal. 2015;12 :1-2.
Okur A, Kantarci M, Karaca L, Ogul H, Aköz A, Kızrak Y, dkk. The utility of cardiac magnetic resonance imaging in Kounis syndrome. Postep Kardiol Inter. 2015;90(5):218–223.
Biteker M. A new classification of Kounis syndrome. Int J Cardiol 2010;145: 553.
Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol. 2010;143(3):223–6.
Kemp SF, Lockey RF, Simons FER. Epinephrine : the drug of choice for anaphylaxis . A statement of the World Allergy Organization. Allergy. 2008;63:1061–1070.

[1] Barrios JL, Gomez F, Perez N, Barrionuevo E, Dona I, Fernandez TD, dkk. Accurate of the diagnosis of allergy reactions at the Emergency Department. J Investig Allergol Clin Immuno. 2019;29(3):1–26.

[2] Acker WW, Plasek JM, Blumenthal KG, Lai KH. Prevalence of food allergies and intolerances documented in electronic health records. J Allergy Clin Immunol. 2017;5:1–6.

[3] Cervellin G, Schirosa F, Buonocore R, Nouvenne A, Borghi L, Meschi T, et al. Spring season birth is associated with higher emergency department admission for acute allergic reactions. Eur J Intern Med. 2015;11:1 - 5.

[4] Simons FER. Anaphylaxis. J Allergy Clin Immunol. 2010; 2:18–23.

[5] Kounis NG, Mazarakis A, Tsigkas, Giannopoulos S, Goudevenos J. Kounis syndrome: a new twist on an old disease. Future Cardiol. 2011;7(6):805–824.

[6] Desai R, Parekh T, Patel U, Fong HK, Samani S, Patel C, dkk. Epidemiology of acute coronary syndrome co-existent with allergic/ hypersensitivity/ anaphylactic reactions (Kounis syndrome) in the United States: A nationwide inpatient analysis, International Journal of Cardiology. 2019;6:1 -16.

[7] Kounis NG. Kounis syndrome : an update on epidemiology , pathogenesis , diagnosis and therapeutic management. Clin Chem Lab Med. 2016;54(10):1545–1559.

[8] Abdelghany M, Subedi R, Shah S, Kozman H. Kounis syndrome : A review article on epidemiology , diagnostic findings , management and complications of allergic acute coronary syndrome. Int J Cardiol. 2017;232:1–4.

[9] Wilson BJ, Musto RJ, Ghali WA. A Case of Histamine Fish Poisoning in a Young Atopic Woman. J Gen Intern Med. 2012;27(7):878–881.

[10] Kounis NG, Patsouras N, Grapsas N, Hahalis G. Histamine induced coronary artery spasm , fish consumption and Kounis syndrome. Int J Cardiol. 2015;193:39–41.

[11] Wickman M. When allergies complicate allergies. Allergy. 2005;60(12):14–18.

[12] Kounis NG, Tsigkas G, Almpanis G, Kouni SN, Kounis GN, Mazarakis A. Anaphylaxis-induced hyperfibrinogenolysis and the risk of Kounis syndrome: the dual action of tryptase. Am J Emerg Med. 2011;29(9):1229–1230.

[13] McGrath SC, Grantdorffer I, Lendeckel U, Ebert MP, Rocken C. Angiotensin II-generating enzymes , angiotensin-converting enzyme (ACE) and mast cell chymase ( CMA1 ), in gastric inflammation may be regulated by H . pylori and associated cytokines. Pathology. 2009;4:419–427.

[14] Riccioni G, Zanasi A, Vitulano N, Mancini B, Orazio ND. Leukotrienes in Atherosclerosis : New Target Insights and Future Therapy Perspectives. Mediator of Inflamation. 2009;2009:1-6.

[15] Cui S, Shibamoto T, Liu W, Takano H, Kurata Y. Effects of platelet-activating factor , thromboxane A2 and leukotriene D4 on isolated perfused rat liver. Prostaglandins & other Lipid Mediators. 2006;80:35–45.

[16] Sciatti E, Vizzardi E, Cani DS, Castiello A, Bonadei I, Savoldi D, et al. Kounis syndrome, a disease to know: Case report and review of the literature. Monaldi Archives for Chest Disease. 2018;88:9–14.

[17] Kounis NG, Koniari I, Soufras GD, Tsigkas G, Chourdakis E, Despotopoulos S, et al. Kounis syndrome : An additional etiologic factor of myocardial infarction with non-obstructive coronary arteries. Cardiology Journal. 2018;25(5):648–649.

[18] Kounis NG. Serum tryptase levels and Kounis syndrome. International Journal of Cardiology. 2007;114:407–408.

[19] Omri M, Kraiem H, Mejri O, Naija M, Chebili N. Management of Kounis syndrome : two case reports. Journal of Medical Case Reports. 2017;11:145–151.

[20] Lippi G, Buonocore R, Schirosa F, Cervellin G. Cardiac troponin I is increased in patients admitted to the emergency department with severe allergic reactions . A case – control study. Int J Cardiol. 2015;194:68–69.

[21] Goto K, Kasama S, Sato M, Kurabayashi M. Myocardial scintigraphic evidence of Kounis syndrome : what is the aetiology of acute coronary syndrome. European Heart Journal. 2015;12 :1-2.

[22] Okur A, Kantarci M, Karaca L, Ogul H, Aköz A, Kızrak Y, dkk. The utility of cardiac magnetic resonance imaging in Kounis syndrome. Postep Kardiol Inter. 2015;90(5):218–223.

[23] Biteker M. A new classification of Kounis syndrome. Int J Cardiol 2010;145: 553.

[24] Cevik C, Nugent K, Shome GP, Kounis NG. Treatment of Kounis syndrome. Int J Cardiol. 2010;143(3):223–6.

[25] Kemp SF, Lockey RF, Simons FER. Epinephrine : the drug of choice for anaphylaxis . A statement of the World Allergy Organization. Allergy. 2008;63:1061–1070.

Seorang penderita syok anafilaksis dengan allergic myocardial infarction (kounis syndrome)

Abstract

References

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