From Allergy to Infarction: A Rare Case of Kounis Syndrome Presenting as ST-elevation Myocardial Infarction

Kounis syndrome refers to the simultaneous occurrence of acute coronary syndrome triggered by mast cell and platelet activation during hypersensitivity, allergic, or anaphylactic reactions. Although several medications and environmental factors have been identified as potential triggers, the complete spectrum of causative agents and the underlying mechanisms remains unclear. Kounis syndrome is frequently underdiagnosed, as distinguishing acute coronary events during episodes of anaphylaxis is challenging due to overlapping clinical features. Therefore, maintaining a strong clinical suspicion is crucial in identifying affected patients. Careful treatment of each entity is necessary, as the pharmacological agent in the treatment of one may adversely affect the other. Effective care of Kounis syndrome requires urgent treatment of ischemia in addition to identifying and managing both the allergic response and the inciting anaphylactic factor to prevent relapse. Here, we describe a Type II Kounis syndrome case: a previously healthy individual presenting with ST-elevation inferior posterior wall myocardial infarction and complete heart block after sustaining multiple bee stings.