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Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report

Received: 18 October 2022     Accepted: 12 November 2022     Published: 22 November 2022
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Abstract

Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.

Published in Clinical Medicine Research (Volume 11, Issue 6)
DOI 10.11648/j.cmr.20221106.12
Page(s) 159-162
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Kounis Syndrome, SARS-CoV-2 Vaccination, Anaphylaxis, Acute Myocardial Infarction

References
[1] The Ministry of Health, Labour and Welfare: The Subcommittee Meeting on Drug Safety of the Committee on the Drug Safety of Pharmaceutical Products of the 28th Pharmaceutical Affairs and Food Sanitation Council. Reported cases of suspected adverse drug reactions: February 18, 2022 (in Japanese).
[2] Kounis NG, Koniari I, Velissaris D, et al: Kounis: Kounis syndrome-not a Single-organ Arterial Disorder but a Multisystem and Multidisciplinary Disease. Balkan Med J 2019; 36: 212-21.
[3] Kounis NG, Hahalis G, Manola A, et al: Kounis syndrome (allergic angina and allergic myocardial infarction). Angina pectoris: etiology, pathogenesis and treatment. Nova Science Publishers, New York, 2008, p 77-150.
[4] Kounis NG, Zavras GM: Histamine-induced coronary artery spasm: the concept of allergic angina. Br J Clin Pract. 1991; 45: 121-8.
[5] Kounis NG. Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management. Clin Chem Lab Med 2016; 54: 1545-59.
[6] Kounis NG. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm? Int J Cardiol 2006; 110: 7-14.
[7] Kounis NG, Mazarakis A, Tsigkas G, et al: Kounis: Kounis syndrome: a new twist on an old disease. Future Cardiol. 2011; 7: 805-24.
[8] Kounis NG, et al: Kounis syndrome. Future Cardiol. 2011; 7: 805-24.
[9] Subhankar C, Umesh Ojha, Bhagya V: Myocardial infarction after COVID-19 vaccination-casual or causal? Diabetes & Metabolic Syndrome: Clinical Research & Reviews 2021: 15: 1055-1056.
[10] Boivin Z, Martin J.: Untimely myocardial infarction or COVID-19 vaccine side effect. Cureus 2021; 13: 13651.
[11] Kounis NG, Koniari I, De Gregorio C, et al: Allergic reactions to current available COVID-19 vaccinations: pathophysiology, causality, and therapeutic considerations. Vaccines 2021; 9: 221.
[12] Takeshi Haoka, Yuka Morishita, Yuki Naito, et al: kounis syndrome presenting with anaphylaxis and vasospastic angina: a case report. Journal of Japanese Association for Acute Medicine 2014; 25: 785-91.
[13] Gomez AG, Romeo EC, Martinez S, et al.: Kounis Syndrome in a patient after administration of influenza vaccine. Allergy 68: 514-5. abstract. 1429.
[14] Kundi H, Gok M, Kiziltun E, et al: A Rarely Seen Type-I Kounis Syndrome Caused By Tetanus Vaccine. Kosuyolu Heart J 2018; 21 (1): 82-4.
[15] Suminobu Ito, Susumu Kusunoki, Nao Tsuchida, et al. FY 2020 Health and Labour and Welfare Policy Research Grant (Research on Emerging and Re-emerging Infectious Diseases and Immunization), an interim report of aggregated data from health observation logs in a focused survey (cohort survey) in the early phase after the start of vaccination for coronavirus disease 2019 (4) (in Japanese) [cited on May 25, 2021]; available from https://www.mhlw.go.jp/content/10906000/000772193.pdf
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  • APA Style

    Tomohisa Tokura, Akihide Konn. (2022). Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report. Clinical Medicine Research, 11(6), 159-162. https://doi.org/10.11648/j.cmr.20221106.12

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    ACS Style

    Tomohisa Tokura; Akihide Konn. Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report. Clin. Med. Res. 2022, 11(6), 159-162. doi: 10.11648/j.cmr.20221106.12

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    AMA Style

    Tomohisa Tokura, Akihide Konn. Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report. Clin Med Res. 2022;11(6):159-162. doi: 10.11648/j.cmr.20221106.12

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  • @article{10.11648/j.cmr.20221106.12,
      author = {Tomohisa Tokura and Akihide Konn},
      title = {Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report},
      journal = {Clinical Medicine Research},
      volume = {11},
      number = {6},
      pages = {159-162},
      doi = {10.11648/j.cmr.20221106.12},
      url = {https://doi.org/10.11648/j.cmr.20221106.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.cmr.20221106.12},
      abstract = {Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.},
     year = {2022}
    }
    

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    AU  - Tomohisa Tokura
    AU  - Akihide Konn
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    AB  - Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.
    VL  - 11
    IS  - 6
    ER  - 

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Author Information
  • Department of Critical and Emergency Medicine, Hachinohe City Hospital, Hachinohe City, Japan

  • Department of Critical and Emergency Medicine, Hachinohe City Hospital, Hachinohe City, Japan

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