Department of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, Japan
Department of Cardiology, Hokkaido Ono Memorial Hospital, Sapporo, Japan.
BMJ Case Rep. 2021 Mar 1;14(3):e240704. doi: 10.1136/bcr-2020-240704.
A 69-year-old woman with a history of allergic reactions to unknown metals who presented 1 year prior with acute coronary syndrome complicated by acute stent thrombosis (ST) was admitted due to new-onset chest pain during mild exercise. She electively underwent coronary angiography, revealing a newly developed stenosis in the fourth branch of the posterior descending artery, treated with an everolimus-eluting stent. One hour later, she reported of sudden chest tightness and nausea; ECG revealed significant ST-segment elevation in the II, III and aVF leads. We suspected ST-segment elevation myocardial infarction resulting from an allergic reaction (ie, Kounis syndrome type III) and managed it properly by eliminating other potential causes. The tentative diagnosis was confirmed by pathological examination of aspirated materials. Kounis syndrome type III may be a frequently undiagnosed clinical entity, emphasising the importance of pathological examination of aspirated materials when implanting coronary stents and history-taking of allergies to stent metals.
一位 69 岁女性，有对未知金属过敏的病史，1 年前因急性冠状动脉综合征并发急性支架血栓形成（ST）就诊。因轻度运动时出现新发胸痛而入院。她择期进行了冠状动脉造影，显示后降支第四分支出现新的狭窄，使用依维莫司洗脱支架治疗。1 小时后，她报告突然出现胸闷和恶心；心电图显示 II、III 和 aVF 导联显著的 ST 段抬高。我们怀疑是由于过敏反应（即 Kounis 综合征 III 型）导致的 ST 段抬高型心肌梗死，并通过排除其他潜在原因进行了适当的处理。通过对抽吸物的病理检查，对疑似病例进行了确诊。Kounis 综合征 III 型可能是一种经常被漏诊的临床实体，这强调了在植入冠状动脉支架时对抽吸物进行病理检查和询问支架金属过敏史的重要性。
