ST-ELEVATION MYOCARDIAL INFARCTION TRIGGERED BY ANAPHYLACTIC SHOCK IN AN ELDERLY PATIENT: ACASE REPORT AND LITERATURE REVIEW

Âu Dương Trung Hào 1 , Ninh Hoàng Phong 1 , Trương Minh Khánh 1 , Lương Đức Khải 1 , Nguyễn Duy Linh 2 , Đào Duy Lượng 2 , Nguyễn Văn Tân 1, 2 ,
1 University of Medicine and Pharmacy at Ho Chi Minh City image/svg+xml
2 Thong Nhat Hospital image/svg+xml
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DOI
10.63947/bvtn.v1i4.21
Published
2025-10-10
Issue Vol. 1 No. 4 (2025): Healthcare in the Digital Age
Section
Case Report
Categories
Research

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Dương Trung Hào Âu, Hoàng Phong N, Minh Khánh T, Đức Khải L, Duy Linh N, Duy Lượng Đào, Văn Tân N. ST-ELEVATION MYOCARDIAL INFARCTION TRIGGERED BY ANAPHYLACTIC SHOCK IN AN ELDERLY PATIENT: ACASE REPORT AND LITERATURE REVIEW. JHA [Internet]. Vietnam; 2025 Oct. 10 [cited 2025 Dec. 8];1(4):129–134. https://tcsuckhoelaohoa.vn/bvtn/article/view/122 doi: 10.63947/bvtn.v1i4.21
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Abstract

Acute myocardial infarction is a leading cause of mortality in the elderly; however, it may present with atypical clinical contexts that require early recognition for timely intervention. We report a unique case of a 77-year-old male with a history of chronic coronary artery disease (previous stenting) and type 2 diabetes mellitus, who developed grade III anaphylaxis following intravenous administration of cefuroxime. The patient was initially managed according to the anaphylactic shock protocol and subsequently transferred to a tertiary hospital in a hemodynamically stable condition, although persistent cutaneous allergic manifestations and dull chest pain were still present. This case illustrates a typical clinical presentation of Kounis syndrome type II (an allergic acute coronary syndrome in a patient with preexisting coronary artery disease), triggered by drug-induced anaphylaxis, and characterized by a biphasic course. In older adults, the diagnosis of Kounis syndrome is particularly challenging due to the high prevalence of underlying coronary artery disease, age-related immune alterations, and polypharmacy—factors that can themselves act as allergens. Furthermore, the elderly often exhibit atypical symptoms, complicating early recognition. Biphasic anaphylaxis, although rare, is a potentially life-threatening phenomenon, especially when superimposed on preexisting cardiovascular disease, as it may exacerbate myocardial ischemia or cause actual infarction.  Vigilant monitoring during the first 24 to 72 hours following the initial anaphylactic episode is essential to enable timely detection and management of potentially life-threatening cardiovascular complications.

Keywords

elderly anaphylatic shock acute coronary syndrome allergy Kounis syndrome

References

  1. Kounis NG. Coronary Hypersensitivity Disorder: The Kounis Syndrome. Clinical Therapeutics. 2013 2013/05/01/;35(5):563-571. doi: https://doi.org/10.1016/j.clinthera.2013.02.022. DOI: https://doi.org/10.1016/j.clinthera.2013.02.022
  2. Alblaihed L, Huis In ‘t Veld MA. Allergic Acute Coronary Syndrome-Kounis Syndrome. Emerg Med Clin North Am. 2022 2022/02//;40(1):69- 78. doi: 10.1016/j.emc.2021.08.010. PubMed PMID: 34782092; eng. DOI: https://doi.org/10.1016/j.emc.2021.08.010
  3. Abdelghany M, Subedi R, Shah S, et al. Kounis syndrome: A review article on epidemiology, diagnostic findings, management
  4. and complications of allergic acute coronary syndrome. International Journal of Cardiology. 2017 2017/04/01/;232:1-4. doi: https://doi. org/10.1016/j.ijcard.2017.01.124. DOI: https://doi.org/10.1016/j.ijcard.2017.01.124
  5. Hanna EB, Glancy DL. ST-segment elevation: Differential diagnosis, caveats. Cleveland Clinic Journal of Medicine. 2015 2015/06;82(6):373- 384. doi: 10.3949/ccjm.82a.14026. DOI: https://doi.org/10.3949/ccjm.82a.14026
  6. Forzese E, Pitrone C, Cianci V, et al. An Insight into Kounis Syndrome: Bridging Clinical Knowledge with Forensic Perspectives. 2024;14(1):91. PubMed PMID: doi:10.3390/life14010091 DOI: https://doi.org/10.3390/life14010091
  7. Renda F, Marotta E, Landoni G, et al. Kounis syndrome due to antibiotics: A global overview from pharmacovigilance databases. International Journal of Cardiology. 2016/12/01/;224:406-411. doi: https://doi. org/10.1016/j.ijcard.2016.09.066. DOI: https://doi.org/10.1016/j.ijcard.2016.09.066
  8. Buttner R, Cadogan M. Kounis Syndrome: LITFL; 2021 [updated 2021/04/21]. Available from: https://litfl.com/kounis-syndrome/
  9. Omri M, Kraiem H, Mejri O, et al. Management of Kounis syndrome: two case reports. Journal of Medical Case Reports. 2017 2017/05/23;11(1):145. doi: 10.1186/s13256- 017-1310-7. DOI: https://doi.org/10.1186/s13256-017-1310-7
  10. Kounis NG, Koniari I, Velissaris D, et al. Kounis Syndrome—not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan medical journal. 2019 Jul 11;36(4):212-221. doi: 10.4274/balkanmedj.galenos.2019.2019.5.62. PubMed PMID: 31198019; PubMed Central PMCID: PMCPMC6636655. eng DOI: https://doi.org/10.4274/balkanmedj.galenos.2019.2019.5.62

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