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ST-Segment Elevation Myocardial Infarction (STEMI) With a Fishy Twist: A Case of Kounis Syndrome Following Seafood Ingestion

Fisher SR, Van Loo AM, Rempakos A, Timmis SB

Cureus, 2026

Abstract

Kounis syndrome is an underrecognized condition characterized by the concurrence of acute coronary syndrome (ACS) and a hypersensitivity reaction mediated by mast cell activation. Diagnosis can be challenging, and treatments for anaphylaxis and ACS may have competing effects. We report a case of a 58-year-old male who presented with anaphylaxis after seafood ingestion, complicated by anterior ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed plaque rupture with thrombus in the mid-left anterior descending artery, consistent with type II Kounis syndrome. This case highlights the importance of early recognition and management to balance treatment of both allergic and ischemic processes.

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