Verma Aakash, Baid Himanshi, Sharma Nakul, Vaya Shuchita, Patel Sanket M
Department of Emergency Medicine, Command Hospital Air Force, Bangalore, Bangalore, IND.
Department of Emergency Medicine, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND.
Cureus. 2022 Nov 14;14(11):e31510. doi: 10.7759/cureus.31510. eCollection 2022 Nov.
Kounis syndrome is the concurrence of acute coronary syndromes associated with allergic or hypersensitivity and anaphylactic or anaphylactoid triggers. Although it is not a rare diagnosis, the different presentations and afflictions of all ages, sex, and racial groups make it a diagnostic challenge. Various triggers include food types, environmental exposure, and drugs. Cases triggered by serum sickness, tetanus antitoxin, and snake bites have been documented in the literature. However, to the best of our knowledge, no case triggered by anti-snake venom (ASV) has been reported yet, as seen in our patient. ASV is composed of refined F(ab) fragments of immunoglobulin G purified from horse or sheep plasma that has been immunized with the venom of different snake species. Evidence of hypersensitivity has been reported with ASV but not with Kounis syndrome. More so, various other vaccinations have also been associated with Kounis syndrome. We present the case of a 30-year-old male who presented to the emergency department with post-snake bite envenomation and neurological symptoms. After the initiation of the anti-snake venom, the patient's neurological signs improved. However, the patient developed acute chest pain. His ECG showed transient ST elevation, and cardiac enzymes and serum IgE levels were raised. A diagnosis of Kounis syndrome was made, and the patient was managed accordingly.
库尼斯综合征是急性冠状动脉综合征与过敏或超敏反应以及过敏或类过敏触发因素同时出现的情况。尽管它并非罕见诊断，但所有年龄、性别和种族群体的不同表现和病症使其成为一项诊断挑战。各种触发因素包括食物类型、环境暴露和药物。血清病、破伤风抗毒素和蛇咬伤引发的病例已在文献中有所记载。然而，据我们所知，如我们的患者所示，尚未有抗蛇毒血清（ASV）引发病例的报告。ASV由从用不同蛇种毒液免疫的马或羊血浆中纯化的免疫球蛋白G的精制F(ab)片段组成。已有关于ASV过敏反应的报道，但未涉及库尼斯综合征。更有甚者，各种其他疫苗接种也与库尼斯综合征有关。我们报告一例30岁男性病例，该患者因被蛇咬伤中毒并出现神经症状而就诊于急诊科。在注射抗蛇毒血清后，患者的神经症状有所改善。然而，患者出现了急性胸痛。其心电图显示短暂性ST段抬高，心肌酶和血清IgE水平升高。诊断为库尼斯综合征，并对患者进行了相应治疗。
