Anti-snake Venom-Induced Kounis Syndrome: A Unique Case in the Emergency Department

Kounis syndrome is the concurrence of acute coronary syndromes associated with allergic or hypersensitivity and anaphylactic or anaphylactoid triggers. Although it is not a rare diagnosis, the different presentations and afflictions of all ages, sex, and racial groups make it a diagnostic challenge. Various triggers include food types, environmental exposure, and drugs. Cases triggered by serum sickness, tetanus antitoxin, and snake bites have been documented in the literature. However, to the best of our knowledge, no case triggered by anti-snake venom (ASV) has been reported yet, as seen in our patient. ASV is composed of refined F(ab)₂ fragments of immunoglobulin G purified from horse or sheep plasma that has been immunized with the venom of different snake species. Evidence of hypersensitivity has been reported with ASV but not with Kounis syndrome. More so, various other vaccinations have also been associated with Kounis syndrome. We present the case of a 30-year-old male who presented to the emergency department with post-snake bite envenomation and neurological symptoms. After the initiation of the anti-snake venom, the patient's neurological signs improved. However, the patient developed acute chest pain. His ECG showed transient ST elevation, and cardiac enzymes and serum IgE levels were raised. A diagnosis of Kounis syndrome was made, and the patient was managed accordingly.