{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T01:08:32Z","timestamp":1781053712135,"version":"3.54.1"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":31,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Anaphylaxis triggered by insect bites is well-documented, but its association with acute myocardial injury (AMI) is rare. We report a case of Kounis syndrome, where an ant bite induced anaphylaxis and myocardial injury. A 47-year-old diabetic male presented with anaphylaxis following an ant bite, exhibiting hypotension, respiratory distress, and wheezing. Electrocardiography revealed transient widespread ST depression and ST elevation in lead aVR, a pattern reflecting global ischemia, which is uncommon in Kounis syndrome. Treatment with intramuscular adrenaline stabilized his condition. Peak troponin T levels were 1306\u00a0ng\/l. Coronary angiography and cardiac MRI were unremarkable, ruling out significant coronary artery disease. The patient was diagnosed with Kounis syndrome and discharged with an EpiPen and instructions for anaphylaxis management. This case highlights the potential for ant bites to trigger anaphylaxis-associated myocardial injury, emphasizing the importance of prompt diagnosis and management of Kounis syndrome in similar scenarios.<\/jats:p>","DOI":"10.1093\/omcr\/omaf020","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T10:33:27Z","timestamp":1745836407000},"source":"Crossref","is-referenced-by-count":2,"title":["Kounis syndrome: acute myocardial injury triggered by ant bite-induced anaphylaxis"],"prefix":"10.1093","volume":"2025","author":[{"given":"Omar","family":"Altermanini","sequence":"first","affiliation":[{"name":"College of Medicine, QU Health, Qatar University , P.O. Box 2713, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9607-4009","authenticated-orcid":false,"given":"Anas A","family":"Ashour","sequence":"additional","affiliation":[{"name":"Internal medicine department, Hamad medical corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waleed K","family":"Abdullatef","sequence":"additional","affiliation":[{"name":"Cardiology department, Heart hospital, Hamad medical corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrahman","family":"Arabi","sequence":"additional","affiliation":[{"name":"Cardiology department, Heart hospital, Hamad medical corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4585-2883","authenticated-orcid":false,"given":"Mhd Baraa","family":"Habib","sequence":"additional","affiliation":[{"name":"Cardiology department, Heart hospital, Hamad medical corporation , P.O. Box 3050, Doha ,","place":["Qatar"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"2025042806332174800_ref1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1111\/j.1742-1241.1991.tb10251.x","article-title":"Histamine-induced coronary artery spasm: the concept of allergic angina","volume":"45","author":"Kounis","year":"1991","journal-title":"Br J Clin Pract"},{"key":"2025042806332174800_ref2","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1515\/cclm-2016-0010","article-title":"Kounis syndrome: an update on epidemiology, pathogenesis, diagnosis and therapeutic management","volume":"54","author":"Kounis","year":"2016","journal-title":"Clin Chem Lab Med"},{"key":"2025042806332174800_ref3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.ijcard.2019.06.002","article-title":"Epidemiology of acute coronary syndrome co-existent with allergic\/hypersensitivity\/anaphylactic reactions (Kounis syndrome) in the United States: a nationwide inpatient analysis","volume":"292","author":"Desai","year":"2019","journal-title":"Int J Cardiol"},{"key":"2025042806332174800_ref4","doi-asserted-by":"publisher","first-page":"91","DOI":"10.3390\/life14010091","article-title":"An insight into Kounis syndrome: bridging clinical knowledge with forensic perspectives","volume":"14","author":"Forzese","year":"2024","journal-title":"Life (Basel)"},{"key":"2025042806332174800_ref5","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ejim.2015.12.004","article-title":"Kounis syndrome: a concise review with focus on management","volume":"30","author":"Fassio","year":"2016","journal-title":"Eur J Intern Med"},{"key":"2025042806332174800_ref6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijcard.2005.08.007","article-title":"Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?","volume":"110","author":"Kounis","year":"2006","journal-title":"Int J Cardiol"},{"key":"2025042806332174800_ref7","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1016\/j.medine.2012.07.002","volume-title":"KOUNIS syndrome. Med Intensiva (Engl Ed)","author":"Rico, Cepeda","year":"2012"},{"key":"2025042806332174800_ref8","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1080\/08998280.2015.11929274","article-title":"Allergic acute coronary syndrome (Kounis syndrome)","volume":"28","author":"Memon","year":"2015","journal-title":"Proc (Bayl Univ Med Cent)"},{"key":"2025042806332174800_ref9","doi-asserted-by":"publisher","first-page":"893","DOI":"10.14744\/AnatolJCardiol.2016.7335","article-title":"Kounis syndrome presenting with acute inferior wall myocardial infarction and cardiogenic shock secondary to intravenous ampicillin\/sulbactam administration","volume":"16","author":"Keskin","year":"2016","journal-title":"Anatol J Cardiol"},{"key":"2025042806332174800_ref10","doi-asserted-by":"publisher","first-page":"250","DOI":"10.5144\/0256-4947.2014.250","article-title":"Kounis syndrome: acute inferior myocardial infarction with atrioventricular node block due to ceftriaxone: a first reported case","volume":"34","author":"Saleh","year":"2014","journal-title":"Ann Saudi Med"},{"key":"2025042806332174800_ref11","doi-asserted-by":"publisher","first-page":"e47507","DOI":"10.7759\/cureus.47507","article-title":"Kounis syndrome: bee sting-induced acute myocardial infarction","volume":"15","author":"Borkar","year":"2023","journal-title":"Cureus"},{"key":"2025042806332174800_ref12","doi-asserted-by":"publisher","first-page":"83","DOI":"10.2174\/011871529X305833240708051508","article-title":"Kounis syndrome: review of clinical cases","volume":"24","author":"Yakushin","year":"2024","journal-title":"Cardiovasc Hematol Disord Drug Targets"},{"key":"2025042806332174800_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s40521-023-00342-9","article-title":"Drug-induced Kounis syndrome: latest novelties","volume":"10","author":"de-Galarreta-Beristain","year":"2023","journal-title":"Curr Treat Options Allergy"},{"key":"2025042806332174800_ref14","first-page":"344","article-title":"Kounis syndrome following solenopsis (fire ant) bite","volume":"74","author":"Ng","year":"2019","journal-title":"Med J Malaysia"},{"key":"2025042806332174800_ref15","doi-asserted-by":"publisher","DOI":"10.1093\/ehjcr\/ytac216","article-title":"Acute coronary syndrome due to plaque erosion likely triggered by insect bites: a case series of Kounis syndrome","volume":"6","author":"Katayama","year":"2022","journal-title":"Eur Heart J Case Rep"}],"container-title":["Oxford Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2025\/4\/omaf020\/63019926\/omaf020.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/omcr\/article-pdf\/2025\/4\/omaf020\/63019926\/omaf020.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T10:33:27Z","timestamp":1745836407000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/omcr\/article\/doi\/10.1093\/omcr\/omaf020\/8121010"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,3,28]]}},"URL":"https:\/\/doi.org\/10.1093\/omcr\/omaf020","relation":{},"ISSN":["2053-8855"],"issn-type":[{"value":"2053-8855","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2025,3,28]]},"article-number":"omaf020"}}