CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 9/10, October/November 2013
e16
AFRICA
Kounis syndrome are similar to ACS cases that are caused
by concurrent thrombosis during plaque rupture or erosion.
In addition, coronary angiography can show coronary artery
spasm, most commonly in the right coronary artery. Kounis
syndrome
11
is related to drug or food allergies and can induce
severe coronary spasm that leads to myocardial infarction and
sudden death.
Pathogenesis of Kounis syndrome may be the result of mast
cell activation by allergic reactions and the subsequent release of
inflammatory mediators, which leads to coronary artery spasm
or plaque rupture. Angiography confirmed coronary artery
spasm in the present patient’s case. The cause of the vasospasm
may have been related to the fact that the patient was prone to
allergies that can induce Kounis syndrome. Six months prior
to admission, the patient had experienced recurring chest pain
after taking progesterone capsules; her medication history of
progesterone clearly correlated with onset of chest pain, which
suggested that the cause of the vasospasm might be related to
progesterone use. However, a cautionary remark is necessary,
as we could not exclude the possibility that pathogenesis of
Kounis syndrome may have been the result of the interaction of
progesterone use and an allergic constitution.
Conclusion
Kounis syndrome is uncommon and is rarely reported
domestically or internationally; the pathogenesis is poorly
understood and requires further study. Therefore, for young
female patients with angina or chest tightness who are prone
to allergies or who have a clinical history of allergies, more
attention should be given to Kounis syndrome. Attention should
also be given to special pathological changes to the coronary
artery, such as vasospasm, which can cause angina, myocardial
infarction or sudden death.
A weakness of this case report is the lack of an intravascular
ultrasound or optical coherence tomography examination.
Also we only found and reported on one case. If specific
characteristics of Kounis syndrome can be identified, they may
be useful potential pathogenic factors for Kounis syndrome. In
the future, specific prevention and therapeutic strategies could
then be implemented.
We acknowledge with thanks the assistance of 3rd Hospital of the Chinese
People’s Liberation Army Pathology Imaging Core for digital whole-slide
imaging of this case.
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