Cefuroxime-axetil induced allergic angina: An insight into classification management of Kounis syndrome

0167-5273/$ – see front matter © 2010 Else doi:10.1016/j.ijcard.2010.04.086 A 40-year-old male patient was admitted to the emergency department with the complaint of severe chest pain just starting 5min after ingesting an oral dose of 500 mg cefuroxime-axetil. His past history was non significant for any allergic disease, hypertension, diabetes mellitus or dyslipidemia. He was a non-smoker. Physical examination including cardiovascular system was normal. There was no apparent sign of allergic reaction. Electrocardiogram showed ST segment elevation in leads D2, D3, aVF compatible with acute inferior myocardial ischemia (Fig. 1A). He was immediately undertaken to the coronary angiography laboratory. When the catheter crossed the ascending aorta, he was relieved from chest pain and ST elevations returned to baseline spontaneously (Fig. 1B). Consequent coronary angiography revealed hemodynamically insignifant plaques in the circumflex and right coronary artery (Fig. 2). He was transferred to the coronary care unit with the diagnosis of coronary spasm secondary to cefuroxime-axetil ingestion. Calcium antagonists and intravenous nitroglycerine were administered. Laboratory analysis showed no elevation of cardiac biomarkers. Transthoracic echocardiography revealed normal wall motions. His recovery was uneventful and he was discharged on his 4th day at the hospital. Development of acute coronary syndrome after exposure to an allergic insult is an unexpected and rarely reported phenomenon. This concept of “the coincidental occurrence of chest pain and allergic reactions accompanied by clinical and laboratory findings of angina pectoris” was first described in 1991 and named as the “Kounis syndrome” [1].