STEMI With a Fishy Twist: A Case of Kounis Syndrome Following Seafood Ingestion

Document Type

Conference Proceeding

Publication Date

4-7-2026

Publication Title

Journal of the American College of Cardiology

Abstract

BACKGROUND Kounis Syndrome (KS) is a rare cause of acute coronary syndrome (ACS) triggered by a mast-cell mediated hypersensitivity reaction. KS can occur through various mechanisms including coronary vasospasm, plaque rupture, or stent thrombosis as a response to allergic mediators. CASE A 58-year-old man with diabetes, hypertension and hyperlipidemia presented to the emergency room (ER) with anaphylactic shock after shellfish ingestion. He had no prior history of angina, however an ECG in the ER showed ST-segment elevation in the anterior leads. He required several doses of epinephrine. Urgent coronary angiography revealed sub-total occlusion of the left anterior descending (LAD) artery due to a ruptured plaque with thrombus (Figure). He underwent PCI of the LAD and had immediate resolution of the ECG changes. An echocardiogram showed preserved left ventricular function. DECISION-MAKING This patient had an anterior ST-segment elevation myocardial infarction (STEMI) during an anaphylactic reaction to shellfish,mostlikelycausedbyruptureofapre-existingplaqueintheLAD.The clinical presentation is consistent with a type II KS. With prompt diagnosis and early reperfusion therapy, the patient had a favorable outcome. CONCLUSION Although hypersensitivity is a rare cause of acute STEMI, early recognition of KS is essential in a patient presenting with a severe allergic reaction to expedite coronary angiography and limit myocardial injury.

Volume

87

Issue

13 Suppl

First Page

A1732

Comments

American College of Cardiology 75th Annual Scientific Session & Expo, March 28-30, 2026, New Orleans, LA

Last Page

A1732

DOI

10.1016/j.jacc.2026.02.4333

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