Perioperative Kounis syndrome in an older adult: case report.

Abstract

Introduction: Kounis syndrome corresponds to myocardial ischemia secondary to the release of inflammatory mediators (mast cell degranulation) during an allergic reaction. Anaphylaxis in adults is commonly triggered by medications, of which antibiotics are the most frequently reported. Objective: To study the presentation and clinical approach of a patient with Kounis syndrome and increase the diagnostic suspicion of a pathology that does not have a standardized treatment or is supported by clinical practice guidelines. Case presentation: The case of a 62 years old adult patient  with precordial pain and anginal equivalents is presented after perioperative anaphylactic shock during programmed open cholecystectomy secondary to cholelithiasis, with subsequent acute myocardial infarction without ST elevation, with arteriography that ruled out lesions in coronary arteries or atheromatous disease. Conclusion: Kounis syndrome is an underdiagnosed entity, with variable clinical presentation and without a specific or standardized treatment, which motivates to carry out a greater casuistry and structure widely disseminated recommendations regarding its treatment.