Type II Kounis Syndrome Secondary to Amoxicillin Allergy

Kounis syndrome is an under-recognized cause of acute coronary syndrome precipitated by allergic or anaphylactic reactions. Recognition is critical, as management requires simultaneous treatment of both conditions.

A 64-year-old woman with cardiovascular risk factors developed anaphylaxis after amoxicillin ingestion. Despite treatment with epinephrine and corticosteroids, she developed chest pain, with electrocardiogram showing inferior ST-segment elevations. Emergent catheterization revealed an occluded mid right coronary artery with nonobstructive left coronary disease. Successful percutaneous intervention was performed with drug-eluting stent placement, consistent with type II Kounis syndrome.

This case represents 1 of approximately 3 reported cases in the literature of type II Kounis syndrome in a female patient secondary to amoxicillin, highlighting the importance of cardiac vigilance during anaphylaxis management.

Kounis syndrome should be suspected when chest pain develops during anaphylaxis, prompting urgent electrocardiographic evaluation. Management requires balancing conflicting therapies for anaphylaxis and acute coronary syndrome.