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J Cardiol Cases . Recurrent Kounis Syndrome - a life-threatening event after COVID-19 vaccine administration

tetano

Editor, Senior Moderator
J Cardiol Cases


. 2022 Feb 7.
doi: 10.1016/j.jccase.2022.01.014. Online ahead of print.
Recurrent Kounis Syndrome - a life-threatening event after COVID-19 vaccine administration


Inês Fialho[SUP] 1 [/SUP], Carolina Mateus[SUP] 1 [/SUP], Gonçalo Martins-Dos-Santos[SUP] 2 [/SUP], Joana Pita[SUP] 2 [/SUP], Nuno Cabanelas[SUP] 1 [/SUP], Sérgio Bravo Batista[SUP] 1 3 [/SUP], David Roque[SUP] 1 [/SUP]



Affiliations

Abstract

Kounis syndrome is an acute coronary syndrome occurring in the setting of a hypersensitivity reaction. It occurs as a consequence of mast-cell activation and degranulation causing coronary artery spasm, atherosclerotic plaque erosion, or stent thrombosis. We report the case of a man who presented to the emergency department with typical angina that started 20 minutes after coronavirus disease 2019 (COVID-19) vaccine administration. Electrocardiogram showed inferior ST-elevation myocardial infarction, and coronary angiography confirmed right coronary artery stent thrombosis. Five months before, he had an acute coronary syndrome after influenza vaccine administration. Both vaccines share a common excipient, polysorbate 80. Considering the reproducibility of the reaction and the temporal association between vaccine administration and coronary events, a hypersensitivity reaction to polysorbate 80 was admitted and the patient was instructed to further avoid drugs containing it. To our knowledge, this constitutes the first reported case of type 3 Kounis syndrome after COVID-19 vaccine administration. Kounis syndrome is an uncommon disease, often undiagnosed. Its recognition and proper management are crucial to prevent future events.

Keywords: Acute coronary syndrome; Coronavirus disease 2019 vaccine; Drug hypersensitivity; Kounis Syndrome.
 
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