Kounis Syndrome: Report of Two Cases with Peculiar Presentation and Diagnostic Issues

  • Alessandro MalobertiEmail author
  • Francesco Pansera
  • Oscar Sala
  • Rossana Fusco
  • Alessandra Pierri
  • Irene Bossi
  • Cristina Giannattasio
Case Report


Kounis Syndrome (KS) is a coronary spasm caused by an allergic reaction that leads to myocardial ischemia or infarction [1]. The main pathological mechanism of KS is the epicardial coronary artery vasospasm due to the release of inflammatory mediators during the allergic reaction. These release is determined by the degranulation and activation of mast cells of the coronary artery wall, leading to vasospasm, erosion/rupture of atherosclerotic plaques or intrastent thrombosis, depending on the coronary anatomy [2].

The first case of association between acute coronary events and allergic reactions has been reported in 1950 [3]. From that paper, few case series and prospective studies [4] has been published.

Since it is an uncommon cause of acute cardiac events and, even more, it frequently goes unnoticed, many gaps in evidence are still presents [1]. Starting from its prevalence estimation and going to the therapeutic option through the diagnostic issues still many questions...


Kounis syndrome Acute coronary syndrome ST elevated myocardial infarction 


Compliance with Ethical Standards


This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of interest

All the authors declares that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Italian Society of Hypertension 2019

Authors and Affiliations

  1. 1.Cardiology 4De Gasperis Cardio Center, Niguarda HospitalMilanItaly
  2. 2.School of Medicine and SurgeryMilano-Bicocca UniversityMilanItaly

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