A 42-year-old woman with eczema developed palpitations, chest pressure, and hypotension within 30 minutes of taking fluconazole for a superinfection. ECG showed ST elevation suggestive of an inferior MI, but angiography revealed no coronary obstruction and normal cardiac function. Labs showed elevated troponin and mild eosinophilia. She stabilized with IV fluids and was diagnosed with Type 1 Kounis syndrome—a hypersensitivity-induced coronary vasospasm in patients without prior cardiac disease.
Kounis syndrome (allergic angina) has three types:
- Type 1: Coronary spasm without underlying disease.
- Type 2: Allergic reaction destabilizes preexisting plaques.
- Type 3: Allergic reaction triggers stent thrombosis.
Triggers include antibiotics, NSAIDs, corticosteroids, and contrast agents. The syndrome is mediated by mast cell degranulation and histamine release, causing vasospasm and a prothrombotic state.
Clinicians should consider Kounis syndrome when allergic symptoms and chest pain coexist.
