An intriguing case of acute coronary syndrome caused by rotten tuna

Kounis and Zavras (1) first described Kounis syndrome (KS) or “syndrome of allergic angina” in 1991, an acute coronary syndrome (ACS) triggered by an anaphylactic or anaphylactoid insult. There are three reported typologies of the disease: coronary vasospasm with no pre-existing coronary artery disease (type I); coronary vasospasm on a pre-existing quiescent plaque, causing its direct erosion or rupture (type II); and stent thrombosis with occluding thrombus (type III). We reported a case of a patient with anaphylactoid type II KS, presenting with acute myocardial infarction because of a distal embolization of a thrombus.