Type 2 Kounis syndrome in an allergic woman: An uncommon presentation of acute coronary syndrome

Abstract Acute coronary syndromes secondary to allergy-induced coronary vasospasm are known as "Kounis syndrome." The main pathophysiological mechanism of coronary spasm in Kounis syndrome is the release of inflammatory mediators during a hypersensitivity reaction triggered by food, insect bites, or drugs. Here, we report a case of an acute coronary syndrome secondary to allergic reaction following levofloxacin administration in a 68-year-old female without a prior history of coronary artery disease. Our patient's coronary angiography revealed moderate lesions in the coronary vasculature and she was diagnosed as having a type II variant Kounis syndrome. Type II variant includes patients in whom the acute release of inflammatory mediators due to mast cell degranulation such as histamine, serotonin, and leukotrienes can induce either coronary artery spasm with normal cardiac enzymes and troponins or plaque erosion or rupture manifesting as acute myocardial infarction. According to our knowledge, this is the first case report of Kounis syndrome attributed to levofloxacin administration. Learning objective: Kounis syndrome is an established entity that describes the triggering of an acute coronary syndrome by an allergic reaction. This is the first case report of Kounis syndrome attributed to levofloxacin administration. We reviewed the literature and present the pathophysiologic mechanism of Kounis syndrome.>