A variant of Kounis syndrome due to diclofenac sodium

Authors

  • Arun Kumar Alagesan Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Kannan R. Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Tirumalasetty Sriharsha Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Vikrannth V. Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Raghav J. Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Vinod Raghavan Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India
  • Monika Reddy Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20230065

Keywords:

Drug induced coronary vasospasm, Anaphylaxis, Kounis syndrome

Abstract

Kounis syndrome is an acute coronary syndrome of varying degrees induced by allergic or anaphylactic reaction leading to coronary vasospasm or atheromatous plaque erosion or rupture or global myocardial hypoperfusion occurring as a result of systemic vasodilation and decreased venous return in context of anaphylaxis. We reported a case of 33-year-old female who presented to emergency department in an irritable state with complaints of nausea, vomiting, abdominal pain, breathlessness and generalized itching which developed secondary to administration of diclofenac injection by intra muscular (IM) route. On evaluation, echocardiography revealed global LV systolic dysfunction. The patient was successfully treated with continuous noradrenaline infusion, fluid resuscitation and other supportive measures with repeat echocardiography revealing normal LV systolic function.

Author Biography

Kannan R., Department of Medicine, Saveetha Medical College, Chennai, Tamil Nadu, India

 

 

References

Kounis NG. Coronary hypersensitivity disorder: the Kounis syndrome. Clin Ther. 2013;35(5):563-71.

Tsigkas G, Chouchoulis K, Theodoropoulos K, Kounis NG, Alexopoulos D. Allergic reaction reveals a non-lethal late stent thrombosis. A new subtype of Kounis syndrome? Int J Cardiol. 2011;149(2):281-2.

Hasegawa S, Tashiro N, Matsubara T, Furukawa S, Ra C. A comparison of FcepsilonRI-mediated RANTES release from human platelets between allergic patients and healthy individuals. Int Arch Allergy Immunol. 2001;125(1):42-7.

Hasegawa S, Pawankar R, Suzuki K, Nakahata T, Furukawa S, Okumura K, Ra C. Functional expression of the high affinity receptor for IgE (FcepsilonRI) in human platelets and its' intracellular expression in human megakaryocytes. Blood. 1999;93(8):2543-51.

Kounis NG, Tsigkas G, Almpanis G, Kouni SN, Kounis GN, Mazarakis A. Anaphylaxis-induced hyperfibrinogenolysis and the risk of Kounis syndrome: the dual action of tryptase. Am J Emerg Med. 2011;29(9):1229-30.

McGrath S, Gräntzdörffer I, Lendeckel U, Ebert MP, Röcken C. Angiotensin II-generating enzymes, angiotensin-converting enzyme (ACE) and mast cell chymase (CMA1), in gastric inflammation may be regulated by H. pylori and associated cytokines. Pathology. 2009;41(5):419-27.

Allen SP, Dashwood MR, Chester AH, Tadjkarimi S, Collins M, Piper PJ, et al. Influence of atherosclerosis on the vascular reactivity of isolated human epicardial coronary arteries to leukotriene C4. Cardioscience. 1993;4(1):47-54.

Riccioni G, Zanasi A, Vitulano N, Mancini B, D'Orazio N. Leukotrienes in atherosclerosis: new target insights and future therapy perspectives. Mediators Inflamm. 2009;2009:737282.

Arshad M, Vijay V, Floyd BC, Marks B, Sarabu MR, Wolin MS, et al. Thromboxane receptor stimulation suppresses guanylate cyclase-mediated relaxation of radial arteries. Ann Thorac Surg. 2006;81(6):2147-54.

Cui S, Shibamoto T, Liu W, Takano H, Kurata Y. Effects of platelet-activating factor, thromboxane A2 and leukotriene D4 on isolated perfused rat liver. Prostaglandins Other Lipid Mediat. 2006;80(1-2):35-45.

Tanniere M, Rochette L. Direct effects of platelet-activating factor (PAF) on cardiac function in isolated guinea pig heart. Drug Rev Res 1987;11:177-86.

Akoz A, Tanboga HI, Emet M, Bayramoglu A, Kizrak Y, et al. A prospective study of Kounis syndrome: clinical experience and cardiac magnetic resonance imaging findings for 21 patients. Acta Med Mediterraea. 2013;9:811-6.

Omri M, Kraiem H, Mejri O, Naija M, Chebili N. Management of Kounis syndrome: two case reports. J Med Case Rep. 2017;11(1):145.

Wu H, Cao Y, Chang F, Zhang C, Hu Y, Liang L. Kounis Syndrome Induced by Anisodamine: A Case Report. Int J Gen Med. 2020;13:1523-7.

Tiwari AK, Tomar GS, Ganguly CS, Kapoor MC. Kounis syndrome resulting from anaphylaxis to diclofenac. Indian J Anaesth. 2013;57(3):282-4.

Fox DJ, Gray TP, Fath-Ordoubadi F. Myocardial infarction after aspirin treatment. J R Soc Med. 2005;98(1):21-3.

Brown AF, McKinnon D, Chu K. Emergency department anaphylaxis: A review of 142 patients in a single year. J Allergy Clin Immunol. 2001;108(5):861-6.

Downloads

Published

2023-01-23

Issue

Section

Case Reports