Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.283
Peer-review started: October 11, 2016
First decision: November 10, 2016
Revised: November 22, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 26, 2017
Kounis syndrome is the concurrence of coronary spasm, acute myocardial infarction or stent thrombosis, with allergic reactions in the setting of mast-cell and platelet activation. In this report Kounis syndrome manifesting as stent thrombosis with left ventricular thrombus formation was triggered by a food-induced allergic reaction. The allergic reaction to food was confirmed by oral rice pudding ingredients challenge test while skin tests were inconclusive. To our knowledge, this is first report of early stent thrombosis secondary to food allergic reaction in a 70-year-old man patient who was found to have left ventricular thrombus and undiagnosed hypertrophic cardiomyopathy.
Core tip: Kounis syndrome highlights, the role of anaphylactic mediated acute coronary syndromes complicating stent thrombosis in the era of invasive treatment of coronary artery disease. Drugs, stings, bites, contrast material, atopic diathesis and even food ingestion could be the culprits. Managing the complex pathophysiology of this condition is a challenging issue, especially in the emergency setting, that requires rapid treatment decisions. The role of detailed past history and of preventive anti-allergic medication in high risk patients with anaphylactic reactions should be considered in randomized studies.