Type I kounis syndrome: A rare st elevation myocardial infarction with normal coronary arteries after honeybee sting

Abstract

The Kounis syndrome is described as an acute coronary syndrome after hymenoptera stings or exposure to environmental toxins or drugs. Bee sting may cause hypersensitivity reaction ranging from simple allergic reaction to life-threatening anaphylactic reaction, sometimes leading to death. Although rare, cardiac involvement is a possible complication, varying from vasospasm to acute ST-elevation myocardial infarction (MI). We report a case of honeybee (Apis cerana indica) sting causing Kounis syndrome. A 36-year-old female, beekeeper in a farm with known allergy to bee venom without any significant cardiovascular risk factors and history had stung by a honeybee on the neck. She presented with features of anaphylaxis and acute inferior wall MI, which was transient and responded to therapy of anaphylaxis. Angiography revealed normal coronaries and patient responded to the standard treatment of anaphylaxis.

Keywords

• Allergic myocardial infarction
• Anaphylaxis
• Honeybee sting
• Hymenoptera
• Ischemic heart disease
• Kounis syndrome