Relapsing allergic bronchopulmonary aspergillosis as a trigger for Kounis syndrome: a case report

Kounis syndrome is an allergic acute coronary syndrome triggered by hypersensitivity reactions. Its association with allergic bronchopulmonary aspergillosis (ABPA) is rarely reported. We describe a 77-year-old woman with asthma, chronic obstructive pulmonary disease, and established ABPA who developed acute chest tightness and dyspnea during an ABPA relapse. Laboratory testing showed marked eosinophilia, elevated total IgE, and evidence of myocardial injury, with increased cardiac troponin I and B-type natriuretic peptide. Electrocardiography revealed ischemic changes, and coronary angiography demonstrated nonobstructive coronary arteries. Based on the clinical and immunologic findings, Kounis syndrome, possibly triggered by ABPA, was diagnosed. The patient improved with antifungal therapy, systemic corticosteroids, coronary vasodilators, and supportive care. This case highlights ABPA relapse as a potential trigger of Kounis syndrome and emphasizes the need for cardiovascular vigilance in patients with severe allergic airway disease.