Kounis Syndrome Triggered by Hymenoptera Stings and Exacerbated by Streptokinase

Kounis syndrome (KS) is an allergy-mediated acute coronary syndrome that is frequently under-recognized and potentially life threatening.

A 52-year-old man developed an inferior ST-segment elevation myocardial infarction following a bee swarm attack. Standard thrombolysis with streptokinase triggered severe hemodynamic collapse and systemic hemorrhage. Upon recognizing KS, management was shifted to steroids and antihistamines, leading to complete recovery. Recurrence was documented 8 years later following an ant bite.

This case illustrates how standard acute coronary syndromes treatments, such as antigenic thrombolytics, can inadvertently exacerbate the allergic cascade in KS. It highlights the need to maintain a high index of suspicion when cardiac symptoms follow an allergic trigger.

Avoid antigenic thrombolytics when KS is suspected to prevent iatrogenic clinical deterioration. Primary percutaneous coronary intervention and early allergy management are the preferred clinical strategies.