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South African Flag Sign in Contrast-Induced Kounis Syndrome: When the Flag Misleads
Subhasish Deb1, Soumya Patra1, Jayanta Roy2
1Department of Cardiology, Manipal Hospitals Mukundapur, Kolkata, India.
Case Summary:
A 45-year-old woman with myasthenia gravis developed acute chest pain minutes after iodinated contrast administration. Electrocardiography showed high lateral ST-segment elevation. Emergent coronary angiography revealed no obstructive disease, with rapid resolution of ST-segment changes. Elevated troponin and regional wall motion abnormality were noted. The temporal association supported a diagnosis of type I Kounis syndrome.
Take-Home Messages:
Contrast-induced hypersensitivity can mimic ST-segment elevation myocardial infarction, with characteristic electrocardiographic patterns. Urgent angiography remains essential when occlusive myocardial infarction cannot be excluded.
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