Kounis Syndrome as a Result of Anaphylactic Reaction to Gold Dust: A Case Report

Abstract

Kounis syndrome (KS) is described as the provocation of an acute coronary syndrome through activation of mast cells resulting in allergy, hypersensitivity, anaphylaxis,or anaphylactoid reaction. The case is here presented of a patient who developed KS with retrosternal chest pain and ST-segment elevation myocardial infarction 30minutes after the ingestion of gold dust. A 40-year-old male without a history of allergy or atopy was admitted to the emergency room with complaints of red, itchy skin,chest pain, and shortness of breath 30 minutes after exposure to gold dust. Arterial blood pressure was 129/72 mmHg, pulse rate was 94 bpm, and oxygen saturationwas 98%. On physical examination, urticarial lesions were observed on the anterior chest wall without uvula edema and pulmonary bronchospasm. Electrocardiogram(ECG) showed ST elevation in the V1-V6 and aVL leads. High sensitivity Troponin I level was measured as 12.1 ng/L (reference=0-19.8 ng/L), and the Troponin I levelsincreased to 229.7 ng/L two hours later. KS was considered because of the findings of chest pain, urticaria on the body, and lack of cardiac disorder. KS should be kept inmind in cases that present with allergic reactions together with chest pain following exposure to agents to which the immune system may be allergic. Cardiac enzymescan either be normal or elevated in these patients. ECG usually has ST, and the T wave changes.