Late stent thrombosis or Kounis syndrome?

We presented a patient suffering an acute anterior myocardial infarction, immediately after an insect sting. Coronary angiogram showed thrombosis of a drug-eluting stent, implanted 15 months ago in proximal LAD. Primary PCI was performed immediately. This is an ambiguous case of late DES thrombosis or Kounis syndrome. The association between them remains unproven. Future studies are needed to elucidate the specific pathways responsible and overlap between them.