Allergic coronary vasospasm induced by ibuprofen: a case of type I Kounis syndrome and literature review
Abstract
Abstract Background Kounis syndrome is defined as acute coronary syndrome triggered by allergic or anaphylactic reactions, and type I Kounis syndrome is characterized by coronary artery spasm without underlying atherosclerotic stenosis. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most common drug triggers, but the condition remains underrecognized due to low clinical awareness, especially in female patients without traditional cardiovascular risk factors. Case presentation A 44-year-old female with atopic constitution presented with persistent chest pain and generalized urticaria 30 minutes after oral administration of 0.3 g ibuprofen sustained-release capsules, accompanied by transient syncope. Electrocardiography showed horizontal ST-segment depression in leads II, III, aVF, and V4–V6. Serum total immunoglobulin E (IgE) was markedly elevated to 430.57 IU/mL, while cardiac injury biomarkers including troponin I and creatine kinase-MB remained within normal ranges. Coronary angiography revealed no organic stenosis or atherosclerotic plaques, with TIMI grade 3 flow in all coronary segments. The patient was diagnosed with type I Kounis syndrome. Symptoms resolved rapidly after treatment with cetirizine for anti-allergy and diltiazem for coronary vasodilation. No recurrence was observed during 1-year follow-up with strict avoidance of NSAIDs. Conclusions Type I Kounis syndrome can be easily misdiagnosed as conventional acute coronary syndrome. Clinicians should…
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