Coronary allograft vasculopathy and coronary vasospasm in heart transplant recipients: a manifestation of Kounis syndrome?

The pathophysiology of vasculopathy of cardiac allografts is still unknown. Coronary vasospasm and thrombosis are some rare manifestations accompanying this entity. Hypersensitivity processes and the hypersensitivity coronary syndrome (Kounis syndrome) may be associated with this potentially fatal complication. Research efforts towards this direction may shed light for prevention and treatment of this disease.

Kounis syndrome: a manifestation of drug-eluting stent thrombosis associated with allergic reaction to contrast material.

Stent components acting as potential antigens and promoting intracoronary mast cell activation can lead to catastrophic intrastent thrombosis. Patients with drug-eluting stent (DES) implantation are prone to hypersensitivity reactions from five potential antigens namely, nickel strut, polymer coating, eluted drug, as well as, concomitant drugs clopidogrel and aspirin. These events may be more common than suspected because it is hard to document them, unless they become systemic, in which case they manifest themselves as the Kounis syndrome characterized by the concurrence of acute coronary events with hypersensitivity reactions. This report concerns of a patient with implanted DES who developed an acute myocardial infarction in the stent area following an allergic reaction to contrast material.

Large hydatic cyst of the left ventricle associated with syncopal attacks.

An unusual case of giant hydatic cyst of the left ventricle producing cardiac and systemic symptomatology is described. The patient had suffered presyncopal and syncopal attacks and the final diagnosis was made by combination of echocardiography, magnetic resonance imaging and serological tests. Surgical resection of the cyst supplemented by medical therapy yielded favorable results.

Penicillin allergy in cancer patients manifesting as Kounis syndrome.

Two cases of allergic angina and allergic myocardial infarction (Kounis syndrome) following penicillin administration are described. The patients suffered from lung and mandible neoplasms and had previously received several courses of antineoplastic therapy without any sequelae. One patient had normal coronary arteries (type I variant of the syndrome) and the other had coronary artery disease with previous myocardial infarction (type II variant of the syndrome). The allergic reaction following penicillin administration seemed to have triggered the development of an acute coronary artery spasm in the first patient and an acute myocardial infarction in the second. This report shows that susceptible individuals expressing a magnified mast cell degranulation effect may be more vulnerable to coronary artery spasm and plaque erosion or rupture.

Pneumomediastinum and cervical emphysema associated with unusual clinical and electrocardiographic manifestations--a case report.

This is the first case reported of combined cervical emphysema and pneumomediastinum associated with unusual electrocardiographic and local neurologic findings. These may be the result of an increase in intracervical and intrathoracic pressure induced by the dissecting air.