Epirubicin-induced Kounis syndrome.

Abstract

BACKGROUND:

Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging.

CASE PRESENTATION:

A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made.

CONCLUSIONS:

Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.

• Authors: Hui-Zhu Liang, Hong Zhao, Jian Gao, Cheng-Fu Cao, Wei-Min Wang
• Journal: BMC cardiovascular disorders (BMC Cardiovasc Disord) Vol. 21 Issue 1 Pg. 133 (03 12 2021) ISSN: 1471-2261 [Electronic] England
• PMID: 33711934 (Publication Type: Case Reports, Research Support, Non-U.S. Gov't)

Chemical References

• Antibiotics, Antineoplastic
• Epirubicin

Topics

• Antibiotics, Antineoplastic (administration & dosage, adverse effects)
• Epirubicin (administration & dosage, adverse effects)
• Humans
• Iliac Artery
• Injections, Intra-Arterial
• Kounis Syndrome (diagnosis, drug therapy, etiology, immunology)
• Male
• Middle Aged
• Treatment Outcome
• Urinary Bladder Neoplasms (drug therapy)