Mohave Rattlesnake Envenomation Causing Allergic Myocardial Infarction (Kounis Syndrome) and Neurotoxic Respiratory Failure

Mohave rattlesnakes (<i>Crotalus scutulatus</i>) are known to inhabit the deserts of southwestern United States, with their territory extending into southern Mexico. Envenomation can impart dramatic local and systemic effects on the body, ranging from local skin necrosis to neurotoxicity, depending on the protein complex in the venom. Kounis syndrome, or allergic angina, is an allergic response to a specific insult that results in myocardial injury often in the form of coronary artery vasospasm but can include myocardial infarction and coronary stent thrombosis. To our knowledge, there have not been any reports associating <i>C scutulatus</i> envenomation with Kounis syndrome. We describe a patient who developed Kounis syndrome presenting as an allergic myocardial infarction following envenomation by a Mohave rattlesnake. A second unique feature of this patient's envenomation is that he experienced respiratory failure secondary to right hemidiaphragmatic paralysis. Severe neurotoxicity from Mohave rattlesnake bites in humans has been reported rarely in the literature.