Kitulwatte Idg, Gangahawatte S, Perera Ulms, Edirisinghe Pas
Department of Forensic Medicine, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Med Leg J. 2017 Dec;85(4):215-218. doi: 10.1177/0025817217695904. Epub 2017 Feb 27.
Kounis syndrome, also known as allergic myocardial infarction or allergic angina syndrome, coincides with chest pain and allergic reactions. It involves the activation of interrelated inflammatory cells following allergic, anaphylactic or anaphylactoid insults. We report a case of Kounis syndrome complicated by an injection of ceftazidime. A 52-year-old man developed shortness of breath and hypotension, leading to immediate unconsciousness, after a ceftazidime injection. Despite intensive care management, he showed no improvement and died approximately 19 h after ceftazidime administration. Autopsy showed massive laryngeal oedema, mucous plugging and collapsed lungs. An ImmunoCAP tryptase assay showed the tryptase level in an autopsy sample to be 118 µg/L (normal < 11.4 µg/L). Microscopy of the myocardium showed cellular infiltration preceding myocardial necrosis. These findings support the pathophysiological theory of Kounis syndrome, with cellular infiltration proposed as the cause of myocardial injury rather than an effect related to the healing process.
库尼斯综合征，也称为过敏性心肌梗死或过敏性心绞痛综合征，与胸痛和过敏反应同时出现。它涉及在过敏、过敏反应或类过敏损伤后相关炎症细胞的激活。我们报告一例因注射头孢他啶而并发库尼斯综合征的病例。一名52岁男性在注射头孢他啶后出现呼吸急促和低血压，随即昏迷。尽管进行了重症监护治疗，但他并无改善，在注射头孢他啶后约19小时死亡。尸检显示有大量喉部水肿、黏液堵塞和肺萎陷。免疫化学发光法检测肥大细胞类胰蛋白酶显示尸检样本中的类胰蛋白酶水平为118μg/L（正常<11.4μg/L）。心肌显微镜检查显示在心肌坏死之前有细胞浸润。这些发现支持库尼斯综合征的病理生理理论，即细胞浸润被认为是心肌损伤的原因，而非与愈合过程相关的结果。
