Kounis Syndrome Triggered During Hysterosalpingography: A Rare Case Associated with Propofol and Iodinated Contrast

Kounis Syndrome (KS) is a rare but life-threatening clinical condition triggered by allergens and capable of resulting in acute coronary syndrome. Contrast agents and anesthetic drugs are among the major triggers, particularly during interventional procedures. This case report describes a case of KS that developed following the administration of propofol sedation and an iodinated contrast agent (iopromide) during a hysterosalpingography (HSG) performed for the assessment of infertility. In a 28-year-old fema-le patient with no known chronic illnesses or history of allergies/anaphylaxis, severe chest pain, skin rashes, respiratory distress and elevated cardiac enzymes developed following the administration of propofol and iodinated contrast medium during the HSG. Coronary angiography performed under the preliminary diagnosis of acute myocardial infarction revealed no significant coronary artery occlusion; consequently, KS was suspected, and the patient was admitted to a tertiary intensive care unit for treat-ment. Rapid clinical improvement was achieved through early administration of intravenous corticoste-roids, antihistamine therapy and mechanical ventilation support; the patient was extubated without complications on the third day and prepared for discharge. KS is a significant clinical condition that may develop suddenly in the context of allergic or anaphylactic reactions, particularly during procedu-res involving contrast media and anesthetic agents, and it carries the potential for a fatal course. Early diagnosis, rapid intervention and a multidisciplinary approach are critical to improving prognosis. Therefore, it is recommended that patients requiring sedation, even for relatively minor procedures such as HSG, have their allergy history carefully assessed, and that such procedures be performed at centers capable of providing advanced intensive care support.