Type II Kounis Syndrome Secondary to Amoxicillin Allergy

BACKGROUND: Kounis syndrome is an under-recognized cause of acute coronary syndrome precipitated by allergic or anaphylactic reactions. Recognition is critical, as management requires simultaneous treatment of both conditions. CASE SUMMARY: A 64-year-old woman with cardiovascular risk factors developed anaphylaxis after amoxicillin ingestion. Despite treatment with epinephrine and corticosteroids, she developed chest pain, with electrocardiogram showing inferior ST-segment elevations. Emergent catheterization revealed an occluded mid right coronary artery with nonobstructive left coronary disease. Successful percutaneous intervention was performed with drug-eluting stent placement, consistent with type II Kounis syndrome. DISCUSSION: This case represents 1 of approximately 3 reported cases in the literature of type II Kounis syndrome in a female patient secondary to amoxicillin, highlighting the importance of cardiac vigilance during anaphylaxis management. TAKE-HOME MESSAGES: Kounis syndrome should be suspected when chest pain develops during anaphylaxis, prompting urgent electrocardiographic evaluation. Management requires balancing conflicting therapies for anaphylaxis and acute coronary syndrome.