Allergic myocardial infarction: Type I Kounis syndrome following blue crab consumption

Abstract

Objectives: Allergic myocardial infarction, known as Kounis syndrome, is an acute myocardial infarction after an allergic reaction to food, drugs, or insect stings, etc. Kounis syndrome can also be caused by all kinds of seafood, such as finned fish, molluscan shellfish, cephalopods, and crustacean shellfish. Methods: Herein, we report a case of a 67-year-old man, with hypertension, referred for itchiness, facial rash, chest pain, and palpitations developed after consumption of blue crab. Results: Electrocardiogram showed ST elevations in leads II,III,aVF. Transthoracic echocardiography revealed inferior wall hypokinezia with a left ventricular ejection fraction of 55%. Coronary angiography revealed no sign of atherosclerosis. The patient was diagnosed to have Kounis Syndrome type I variant, secondary to blue crab ingestion. He was treated with oral antihistamines and prednisolone.The repeated cardiac markers were within normal limits, with resolution of electrocardiographic abnormalities and inferior wall motion echocardiographic changes. Conclusion: All patients admitted to the emergency department with chest pain and ST elevation on electrocardiography should be asked about allergic insults.