Cefuroxime-associated Kounis syndrome with unique peculiarity in perioperative prophylaxis

Cefuroxime is a broad spectrum antibacterial agent administered in cases of perioperative prophylaxis. Kounis syndrome is defined as the concurrence of anaphylactic events with acute coronary syndromes. Limited data is available for cefuroxime-associated Kounis syndrome in perioperative prophylaxis. We report the case of a 37-year-old woman undergoing bilateral sweat gland resection who presented with Kounis syndrome following cefuroxime infusion for perioperative prophylaxis. The patient had severe symptoms and unique manifestations that never been reported before: pink frothy sputum indicating heart failure, due to severe systolic dysfunction requiring invasive ventilation and intra-aortic balloon counter-pulsation. Cefuroxime-associated Kounis syndrome has several unique and life-threatening peculiarities which broaden our understanding of clinical and laboratory characteristics. It is important for physicians to be aware of possible cardiovascular complications in perioperative cefuroxime prophylaxis.