Kounis Syndrome after Oral Amoxicillin Clavulanate

Kounis or allergic vasospastic angina has been described after exposure to several foods, drugs, and insect bites and stings. Mast cell degranulation during a hypersensitivity allergic or anaphylactic reaction leads to inflammatory mediators causing coronary spasm and thrombosis. A 44-year-old female with no comorbidities presented with sweating, dizziness, rashes, chest tightness, and epigastric discomfort 1 h after oral amoxicillin clavulanate. Electrocardiogram (ECG) showed ST segment changes along with elevated troponin I. Suspecting Kounis syndrome, she was administered pheniramine maleate, hydrocortisone, and oral antiplatelets along with intravenous fluids. Chest tightness was better, and ECG improved in 60 min. Since systemic adrenaline was to be avoided for fear of coronary vasospasm, for airway edema, nebulized adrenaline was administered. She recovered completely and was discharged after 48 h. This case highlights coronary vasospasm during an ongoing allergic reaction and its management with antihistamines, steroids, and antiplatelet drugs. Nebulized adrenaline was safely given with ECG monitoring for airway edema.