Katayama Yosuke, Taniguchi Motoki, Ota Shingo, Satogami Keisuke, Ozaki Yuichi, Ino Yasushi, Tanaka Atsushi
Department of Cardiovascular Medicine, Shingu Municipal Medical Center, Shingu, Japan.
Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
Eur Heart J Case Rep. 2022 May 23;6(6):ytac216. doi: 10.1093/ehjcr/ytac216. eCollection 2022 Jun.
Kounis syndrome is the concurrence of acute coronary syndrome (ACS), including coronary spasm, acute myocardial infarction, and stent thrombosis due to an allergic and/or anaphylactoid insult.
We present two cases of Kounis syndrome likely triggered by insect bites, with plaque erosion demonstrated using optical coherence tomography (OCT). Three common findings were derived from this case series. First, the patients developed a rash after an insect bite followed by ACS. Second, immunoglobulin E levels were increased. Finally, OCT identified the aetiology of ACS in this case series as erosion of the culprit lesions.
Kounis syndrome, which is ACS following allergic reactions due to insect bites, is a rare complication. Kounis syndrome is probably not uncommon, but underdiagnosed. It is important for physicians to consider the treatment of Kounis syndrome in the complex course of ACS associated with allergic reactions. Furthermore, patients with a history of Kounis syndrome should avoid antigen exposure during secondary prophylaxis. In some cases, it may take several days from antigen exposure to the onset of ACS. Considering Kounis syndrome is beneficial for early diagnosis and appropriate treatment.
库尼斯综合征是急性冠状动脉综合征（ACS），包括冠状动脉痉挛、急性心肌梗死和因过敏和/或类过敏反应导致的支架血栓形成的并发情况。
我们报告了两例可能由昆虫叮咬引发的库尼斯综合征病例，通过光学相干断层扫描（OCT）显示有斑块侵蚀。该病例系列得出了三个常见发现。第一，患者在昆虫叮咬后出现皮疹，随后发生ACS。第二，免疫球蛋白E水平升高。最后，OCT确定该病例系列中ACS的病因是罪犯病变的侵蚀。
库尼斯综合征是昆虫叮咬引起过敏反应后的ACS，是一种罕见的并发症。库尼斯综合征可能并不罕见，但诊断不足。对于医生来说，在与过敏反应相关的ACS复杂病程中考虑库尼斯综合征的治疗很重要。此外，有库尼斯综合征病史的患者在二级预防期间应避免接触抗原。在某些情况下，从接触抗原到ACS发作可能需要几天时间。考虑到库尼斯综合征有利于早期诊断和适当治疗。
