Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.
| Published in | Clinical Medicine Research (Volume 11, Issue 6) |
| DOI | 10.11648/j.cmr.20221106.12 |
| Page(s) | 159-162 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2022. Published by Science Publishing Group |
Kounis Syndrome, SARS-CoV-2 Vaccination, Anaphylaxis, Acute Myocardial Infarction
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| [3] | Kounis NG, Hahalis G, Manola A, et al: Kounis syndrome (allergic angina and allergic myocardial infarction). Angina pectoris: etiology, pathogenesis and treatment. Nova Science Publishers, New York, 2008, p 77-150. |
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| [12] | Takeshi Haoka, Yuka Morishita, Yuki Naito, et al: kounis syndrome presenting with anaphylaxis and vasospastic angina: a case report. Journal of Japanese Association for Acute Medicine 2014; 25: 785-91. |
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| [15] | Suminobu Ito, Susumu Kusunoki, Nao Tsuchida, et al. FY 2020 Health and Labour and Welfare Policy Research Grant (Research on Emerging and Re-emerging Infectious Diseases and Immunization), an interim report of aggregated data from health observation logs in a focused survey (cohort survey) in the early phase after the start of vaccination for coronavirus disease 2019 (4) (in Japanese) [cited on May 25, 2021]; available from https://www.mhlw.go.jp/content/10906000/000772193.pdf |
APA Style
Tomohisa Tokura, Akihide Konn. (2022). Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report. Clinical Medicine Research, 11(6), 159-162. https://doi.org/10.11648/j.cmr.20221106.12
ACS Style
Tomohisa Tokura; Akihide Konn. Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report. Clin. Med. Res. 2022, 11(6), 159-162. doi: 10.11648/j.cmr.20221106.12
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Download@article{10.11648/j.cmr.20221106.12,
author = {Tomohisa Tokura and Akihide Konn},
title = {Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report},
journal = {Clinical Medicine Research},
volume = {11},
number = {6},
pages = {159-162},
doi = {10.11648/j.cmr.20221106.12},
url = {https://doi.org/10.11648/j.cmr.20221106.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20221106.12},
abstract = {Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.},
year = {2022}
}
TY - JOUR T1 - Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report AU - Tomohisa Tokura AU - Akihide Konn Y1 - 2022/11/22 PY - 2022 N1 - https://doi.org/10.11648/j.cmr.20221106.12 DO - 10.11648/j.cmr.20221106.12 T2 - Clinical Medicine Research JF - Clinical Medicine Research JO - Clinical Medicine Research SP - 159 EP - 162 PB - Science Publishing Group SN - 2326-9057 UR - https://doi.org/10.11648/j.cmr.20221106.12 AB - Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged. VL - 11 IS - 6 ER -
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