Vancomycin-induced Kounis Syndrome |
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| Affiliation: | 1. Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA;2. St Mary''s Medical Center, West Palm Beach, FL, USA;1. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America;2. Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, United States of America;3. Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, United States of America;1. VA Tennessee Valley Healthcare System—Nashville, Department of Emergency Medicine, Nashville, TN, USA;2. Vanderbilt University, Department of Emergency Medicine, Nashville, TN, USA;3. Louis Stokes Cleveland VA Medical Center, Medicine Service, Cleveland, OH, USA;4. Case Western Reserve University School of Medicine, Department of Medicine, Cleveland, OH, USA;5. Orlando VA Medical Center, Department of Emergency Medicine, Orlando, FL, USA;6. University of Central Florida College of Medicine, Department of Medicine, Orlando, FL, USA;7. VA Pittsburgh Health Care Systems, Critical Care Service, Pittsburgh, PA, USA;8. University of Pittsburgh, Departments of Critical Care Medicine and Emergency Medicine, Pittsburgh, PA, USA;9. South Texas Veterans Health Care System, Medicine Service, San Antonio, TX, USA;10. UT Health San Antonio, Division of General & Hospital Medicine, San Antonio, TX, USA;11. White River Junction VA Medical Center, Medicine Service, White River, Junction, VT, USA;12. Dartmouth Geisel School of Medicine, Department of Medicine, Hanover, NH, USA;13. (m) UT Health San Antonio, Division of Pulmonary & Critical Care Medicine, San Antonio, TX, USA;14. Durham VA Health Care System, Primary Care Service, Durham, NC, USA;15. Duke University School of Medicine, Department of Medicine, Durham, NC, USA;p. VHA Specialty Care Service, VACO, Washington, DC, USA;1. Department of Internal Medicine, Boston Medical Center, Boston, MA, USA;2. Section of Gastroenterology, Boston Medical Center, Boston, MA, USA;3. Boston University School of Public Health, Boston, MA, USA;1. Division of Emergency Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA;2. Department of Radiology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA;3. Value Institute, Christiana Care Health System, Newark, DE, USA |
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| Abstract: | Kounis Syndrome is a rare allergic reaction that results in coronary vasospasm and may occur in patients with and without coronary artery disease. A 57-year-old man receiving pre-operative vancomycin for osteomyelitis and gangrene of the foot experienced an episode of anginal symptoms associated with transient ischemic 12-lead electrocardiogram (ECG) changes. The patient's symptoms and ECG changes abated with discontinuation of vancomycin and subsequent coronary angiography revealed no evidence of coronary artery disease. Treatment of Kounis Syndrome begins with cessation of the causative agent. Consensus guidelines for the management of Kounis Syndrome have not been established but treatment should both dilate the coronary vessels and suppress the allergic response. Coronary vasospasm after administration of antibiotics, including vancomycin, is a rare but serious reaction. It is important that Emergency Physicians recognize Kounis Syndrome as an uncommon yet dramatic and consequential reaction to such a commonly-administered antibiotic. |
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