ABSTRACT

Our case report describes a 32-year old woman who had myocardial infarction with anaphylactic shock second- ary to penicillin injection. She had hypotension and chest pain after 1.2000.000 U penicillin G injection for criptic tonsillitis. Her ECG showed ST elevation on D1 and aVL derivations and ST depression and T wave inversion on D2,D3,aVF, V3–6 derivations. Her ECG abnormalities regressed after the chest pain resolved. Her serum troponin level was elevated to 5.2 ng/ml. She had no pathology on echocardiographic examination. She was given anti- platelet and anti-thrombotic treatment, monitorized and followed in intensive coronary care unit. No cardiac complications were observed in her follow-up. Her coronary angiography was completely normal. The hyperven- tilation test to induce coronary spasm was negative during the coronary angiography. The myocardial injury seen in this case may be due to hypotension, allergic reaction itself, the potential vasospasm at the time of the anaphy- lactic shock or to intravenous adrenalin administered. Such cases of Kounis syndrome with anaphylactic shock are rarely observed. Emergency physicians should be aware of Kounis syndrome when there is a young patient without any risk factors having chest pain after an allergic insult.

Keywords: Kounis syndrome Myocardial infarction Penicillin Anaphylactic shock