Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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A Case of Zaltoprofen Induced Kounis Syndrome

잘토프로펜 유발 Kounis 증후군 1례

  • Lee, Seong You (Department of Emergency Medicine, College of Medicine, Eulji University) ;
  • Sung, Won Young (Department of Emergency Medicine, College of Medicine, Eulji University) ;
  • Lee, Jang Young (Department of Emergency Medicine, College of Medicine, Eulji University) ;
  • Seo, Sang Won (Department of Emergency Medicine, College of Medicine, Eulji University) ;
  • Lee, Won Suk (Department of Emergency Medicine, College of Medicine, Eulji University)
  • 이성유 (을지대학교 의과대학 응급의학교실) ;
  • 성원영 (을지대학교 의과대학 응급의학교실) ;
  • 이장영 (을지대학교 의과대학 응급의학교실) ;
  • 서상원 (을지대학교 의과대학 응급의학교실) ;
  • 이원석 (을지대학교 의과대학 응급의학교실)
  • Received : 2019.03.28
  • Accepted : 2019.04.13
  • Published : 2019.06.30
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Abstract

Kounis syndrome is defined as the occurrence of acute coronary syndrome associated with vasoactive mediators, such as histamines in the setting of hypersensitivity and allergic reactions or anaphylactic insults. The condition can be caused by various drugs, foods, or environmental factors that cause allergic reactions. A 35-year-old male visited the emergency room with anaphylaxis accompanied by chest pain approximately 20 minutes after taking zaltoprofen, a nonsteroidal anti-inflammatory drug. After acute treatment for the anaphylaxis, the patient was stabilized and all symptoms disappeared, but the ischemic changes in the electrocardiogram and elevation of the cardiac enzymes were observed. The emergency cardiac angiography and echocardiography were all normal. The allergic reaction of this patient to zaltoprofen was believed to cause a temporary coronary arterial vasospasm, inducing Type 1 Kounis syndrome. Thus far, there have been case reports of Kounis syndrome caused by a range of nonsteroidal anti-inflammatory drugs, but there are no reports of the condition being caused by zaltoprofen. According to the pathophysiology, both cardiac and allergic symptoms must be solved simultaneously, so rapid treatment and diagnosis are needed. Doctors treating acute allergic reactions and anaphylaxis patients must check the cardiovascular symptoms thoroughly and consider the possibility of Kounis syndrome.

Keywords

References

  1. Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med 2016;54:1545-59. https://doi.org/10.1515/cclm-2016-0010
  2. Renda F, Landoni G, Trotta F, et al. Kounis Syndrome: An analysis of spontaneous reports from international pharmacovigilance database. Int J Cardiol 2016;203:217-20. https://doi.org/10.1016/j.ijcard.2015.10.003
  3. Renda F, Marotta E, Landoni G, et al. Kounis syndrome due to antibiotics: A global overview from pharmacovigilance databases. Int J Cardiol 2016;224:406-11. https://doi.org/10.1016/j.ijcard.2016.09.066
  4. Choi EJ, Shin YH, Na DK, et al. A case of Kounis syndrome induced by a non-steroidal anti-inflammatory drug. Korean J Med 2012;82:724-8. https://doi.org/10.3904/kjm.2012.82.6.724
  5. Cagliyan CE, Balli M, Tekin K, et al. Kounis syndrome triggered by diclofenac sodium injection which leads to myocardial infarction and cardiac arrest. J Cardiol Cases 2013;8:e17-9. https://doi.org/10.1016/j.jccase.2013.03.002
  6. Martinez-Torres PS, Hernandez-Reyes A, Lozada-Martinez GC, et al. Allergic myocardial ischemia secondary to ibuprofen, Kounis syndrome. Case report. Rev Mex Cardiol 2018;29:37-40.
  7. Altay S, Cakmak HA, Erer B, et al. The allergic angina syndrome in naproxen sodium induced type 1 hypersensitivity reaction in an allergic asthmatic young woman: Kounis syndrome. Acta Cardiol Sin 2102;28:152-6.
  8. Kounis NG, Zavras GM. Histamine-induced coronary artery spasm: The concept of allergic angina. Br J Clin Pract 1991;45:121-8.
  9. Kim SY, Lee SP, Lee SM. Approaches to the diagnosis and management of hypersensitivity reactions to aspirin and nonsteroidal anti-inflammatory drugs. JPERM 2018;10:49-53.
  10. Kang HY, Park SA, Kim DH, et al. Bioequivalence of SCD Zaltoprofen Tablet to Soleton Tablet (Zaltoprofen 80 mg). J Kor Pharm Sci 2006;36:271-7.
  11. Hatori M, Kokubun S. The long-term efficacy and tolerability of the new anti-inflammatory agent zaltoprofen in rheumatoid arthritis. Curr Med Res Opin 1998;14:79-87. https://doi.org/10.1185/03007999809113346
  12. Hangouche AJE, Lamliki O, Oukerraj L, et al. Kounis syndrome induced by oral intake of aspirin: case report and literature review. Pan Afr Med J 2018;30:301. DOI: 10.11604/pamj.2018.30.301.14948.
  13. Biteker M. Current understanding of Kounis syndrome. Expert Rev Clin Immunol 2010;6:777-88. https://doi.org/10.1586/eci.10.47
  14. Felix SB, Baumann G, Berdel WE. Systemic anaphylaxis - separation of cardiac reactions from respiratory and peripheral vascular events. Res Exp Med (Berl) 1990;190:239-52. https://doi.org/10.1007/BF00000029
  15. Zavecz JH, Levi R. Separation of primary and secondary cardiovascular events in systemic anaphylaxis. Circ Res 1977;40:15-9. https://doi.org/10.1161/01.RES.40.1.15
  16. Davidson J, Zheng F, Tajima K, et al. Anaphylactic shock decreases cerebral blood flow more than what would be expected from severe arterial hypotension. Shock 2012;38:429-35. https://doi.org/10.1097/SHK.0b013e3182690897
  17. Kounis NG, Soufras GD, Hahalis G. Anaphylactic shock: Kounis hypersensitivity-associated syndrome seems to be the primary cause. N Am J Med Sci 2013;5:631-6. https://doi.org/10.4103/1947-2714.122304
  18. Li J, Zheng J, Zhou Y, et al. Acute coronary syndrome secondary to allergic coronary spasm (Kounis Syndrome): a case series, follow-up and literature review. BMC Cardiovasc Diord 2018;18:42. DOI: 10.1186/s12872-018-0781-9.
  19. Jeong JW. Diagnostic and acute management of anaphylaxis. J Korean Med Assoc 2014 ;57:934-40. https://doi.org/10.5124/jkma.2014.57.11.934