A case of Kounis syndrome after a hornet sting and literature review

BMC Research Notes

Senanayake Abeysinghe Mudiyanselage Kularatne¹  Dissanayake Mudiyanselage Priyantha Udaya Kumara Ralapanawa¹ 

[1] Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

关键词: Sri Lanka;    Vespa affinis;    Acute coronary syndrome;    Kounis syndrome;   

Others  :  1118069
DOI  :  10.1186/1756-0500-7-867

 received in 2014-08-12, accepted in 2014-11-26,  发布年份 2014

【 摘 要 】

Background

Acute coronary syndrome after hymenoptera stings or exposure to environment toxins is referred to as the Kounis syndrome or allergic myocardial ischaemia with or without infarction. We report a case of hornet (Vespa affinis) sting causing Kounis syndrome in Sri Lanka and present a review of literature.

Case presentation

A 60-year -old female with diabetes mellitus and known allergy to bee venom was stung by a hornet on the right hand. Within 30 minutes she developed hypotension and wide spread T wave inversion in the 12 leads ECG that remained unchanged about 5 hours and reversed back to normal.

Conclusion

Hymenoptera stings can induce acute coronary syndrome either by direct effect of venom constituents on the coronary endothelium or through inflammatory mediators induced allergic reaction on coronary vasculature. Early recognition of Kounis syndrome is needed in hornet stings to implement necessary treatments.

【 授权许可】

   
2014 Ralapanawa and Kularatne; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Kularatne K, Kannangare T, Jayasena A, Jayasekera A, Waduge R, Weerakoon K, Kularatne SA: Fatal acute pulmonary oedema and acute renal failure following multiple wasp/hornet(Vespa affinis) stings in Sri Lanka:two case reports. J Med Case Rep 2014, 8:188. BioMed Central Full Text
• [2]Kogias JS, Sideris SK, Anifadia SK: Kounis syndrome associated with hypersensitivity to hymenoptera stings. Int J Cardiol 2007, 114(2):252-255.
• [3]Rekik S, Andrieu S, Aboukhoudir F, Barnay P, Quaino G, Pansieri M, Hirsch JL: ST elevation myocardial infarction with no structural lesions after a wasp sting. J Emerg Med 2012, 42(4):e73-e75.
• [4]Jones E, Joy M: Acute myocardial infarction after a wasp sting. Br Heart J 1988, 59:506-508.
• [5]Bach MK: Mediators of anaphylaxis and inflammation. Annu Rev 1982, 36:371-413.
• [6]Michelassi F, Landa L, Hill RD, Lowenstein E, Watkins WD, Petkau AJ, Zapol WM: Leukotriene D4:a potent coronary artery vasoconstrictor associated with impaired ventricular contraction. Science 1982, 217:841-843.
• [7]Piper PJ: Pharmacology of leukotrienes. Br Med Bull 1983, 39:255-259.
• [8]Habermann E: Bee and wasp venoms. Science 1972, 177:314-322.
• [9]Levine HD: Acute myocardial infarction following wasp sting. Am Heart J 1976, 91:365-374.
• [10]Milne MD: Unusual case of coronary thrombosis. Br Med J 1949, 1(4616):1123.
• [11]O’Brien JR: Some effects of adrenaline and anti-adrenaline compounds on platelets in vitro and vivo. Nature 1963, 200:763-764.
• [12]Sinkiewiez W, Sobanski P, Zbigniew B: Allergic myocardial infarction. Cardiol J 2008, 15(3):220-225.
• [13]Bonadonna P, Perbellini O, Passalacqua G, Caruso B, Colarossi S, Dal Fior D, Castellani L, Bonetto C, Frattini F, Dama A, Martinelli G, Chilosi M, Senna G, Pizzolo G, Zanotti R: Clonal mast cell disorders in patients with systemic reaction to Hymenoptera stings and increased tryptase levels. J Allergy Clin Immunol 2009, 123(3):680-686.
• [14]Kounis NG, Mazarakis A, Tsigkas C, Giannopoulos S, Goudevanos J: Kounis syndrome: a new twist on an old disease. Future Cardiol 2011, 7(6):805-824.
• [15]Hamilos MI, Kochiadakis GE, Skalidis EI, Igoumenidis NE, Zaharaki A, Vardas PE: Acute myocardial infarction in a patient with normal coronary arteries after an allergic reaction. Hellenic J Cardiol 2005, 46:79-82.
• [16]Kounis NG: Kounis syndrome(allergic angina and allergic myocardial infarction):A natural paradigm? Int J Cardiol 2006, 110:7-14.