Kounis syndrome

Abstract

Kounis syndrome is characterised by a group of symptoms that manifest as unstable vasospastic or non-vasospastic angina secondary
to a hypersensitivity reaction. It was first described by Kounis and Zavras in 1991 as the concurrence of an allergic response with an
anaphylactoid or anaphylactic reaction and coronary artery spasm or even myocardial infarction. Since then, this condition has evolved to
include a number of mast cell activation disorders associated with acute coronary syndrome. There are many triggering factors, including
reactions to multiple medications, exposure to radiological contrast media, poison ivy, bee stings, shellfish and coronary stents. In addition
to coronary arterial involvement, Kounis syndrome comprises other arterial systems with similar physiologies, such as mesenteric and
cerebral circulation resulting in ischaemia/infarction of the vital organs. The incidence of this condition is difficult to establish owing to the
number of potential instigating factors and its relatively infrequent documentation in the literature.
We report the case of an HIV-negative 39-year-old man with no coronary risk factors or family history of premature coronary artery
disease, who developed Kounis syndrome after the administration of fluoroquinolone for dysuria. However, to the best of our knowledge,
no data on the incidence and prevalence of Kounis syndrome in South Africa have ever been reported in the literature. The recent
understanding of Kounis syndrome has led to the condition being classified into three syndrome variants.