{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T21:06:23Z","timestamp":1790456783971,"version":"4.1.0"},"reference-count":27,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,1,1]]},"abstract":"<jats:p>Kounis syndrome defined as the appearance of acute coronary syndrome in the context of an allergic reaction is a relatively rare phenomenon. There are three variants of this syndrome in which the patient presents with symptoms of an acute chest. Herein, we describe a case of an 83-year-old woman who demonstrated type I variant of Kounis syndrome in response to vancomycin administration. After initialisation of vancomycin, she became unresponsive and an ECG demonstrated ST changes consistent with inferior-lateral myocardial infarction. Once allergic stimulus was removed, ECG normalised. Differential diagnosis includes, myocardial infarctions, angina as well as intravascular stent thrombosis, which must all be ruled out. The patient was monitored and discharged soon thereafter.<\/jats:p>","DOI":"10.1136\/bcr-2017-222846","type":"journal-article","created":{"date-parts":[[2018,1,18]],"date-time":"2018-01-18T00:41:01Z","timestamp":1516236061000},"page":"bcr-2017-222846","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Vancomycin-induced coronary artery spasm: a case of Kounis syndrome"],"prefix":"10.1136","volume":"2018","author":[{"given":"Eric","family":"Martinez","sequence":"first","affiliation":[{"name":"Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonu","family":"Sahni","sequence":"additional","affiliation":[{"name":"Department of Primary Care, Touro College of Osteopathic Medicine, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad AI","family":"Cheema","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asma","family":"Iftikhar","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, New York Presbyterian Hospital Queens, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,17]]},"reference":[{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.1","doi-asserted-by":"crossref","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":"2025082703255850000_2018.jan17_1.bcr-2017-222846.2","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1053\/j.jvca.2016.12.023","article-title":"Anaphylaxis during intracardiac and endovascular implantations: a multifactorial problem involving kounis syndrome","volume":"31","author":"Kounis","year":"2017","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.3","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.ijcard.2015.06.072","article-title":"Kounis syndrome: report of 3 cases","volume":"197","author":"Katsanou","year":"2015","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.4","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1016\/j.ijcard.2016.09.066","article-title":"Kounis syndrome due to antibiotics: a global overview from pharmacovigilance databases","volume":"224","author":"Renda","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.5","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.ijcard.2005.11.088","article-title":"Serum tryptase levels and kounis syndrome","volume":"114","author":"Kounis","year":"2007","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.6","first-page":"508","article-title":"Allergic angina and allergic myocardial infarction: a new twist on an old syndrome","volume":"18","author":"Nikolaidis","year":"2002","journal-title":"Can J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2010.05.020"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.8","doi-asserted-by":"publisher","DOI":"10.1016\/1053-0770(91)90009-I"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.9","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/157.3.502"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.10","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1016\/S0025-6196(12)62773-6","article-title":"Adverse effects of vancomycin administered in the perioperative period","volume":"61","author":"Southorn","year":"1986","journal-title":"Mayo Clin Proc"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.11","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-200205000-00009"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2013.02.022"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2010.02.040"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.14","doi-asserted-by":"publisher","DOI":"10.2143\/AC.60.3.2005015"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.15","doi-asserted-by":"publisher","DOI":"10.1007\/s00380-004-0804-6"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.16","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/j.ijcard.2006.11.165","article-title":"Kounis syndrome secondary to amoxicillin\/clavulanic acid use","volume":"124","author":"Tavil","year":"2008","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.17","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1111\/j.1532-5415.2008.01912.x","article-title":"Kounis syndrome secondary to cefuroxime-axetil use in an octogenarian","volume":"56","author":"Biteker","year":"2008","journal-title":"J Am Geriatr Soc"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2008.04.064"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.19","doi-asserted-by":"crossref","first-page":"e30","DOI":"10.1016\/j.ijcard.2008.03.069","article-title":"Acute ST segment elevation myocardial infarction after sulbactam-ampicilllin induced anaphylactic shock in an adult with significant coronary artery disease: a case report","volume":"135","author":"Kilic","year":"2009","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.20","doi-asserted-by":"crossref","first-page":"e42","DOI":"10.1016\/j.ijcard.2011.07.049","article-title":"Kounis syndrome induced by intravenous administration of piperacillin\/tazobactam: a case report","volume":"155","author":"Calogiuri","year":"2012","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.21","doi-asserted-by":"crossref","first-page":"250","DOI":"10.5144\/0256-4947.2014.250","article-title":"Kounis syndrome: acute inferior myocardial infarction with atroventricular node block due to ceftriaxone: a first reported case","volume":"34","author":"Saleh","year":"2014","journal-title":"Ann Saudi Med"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.22","doi-asserted-by":"crossref","first-page":"461","DOI":"10.5543\/tkda.2014.92891","article-title":"Acute coronary syndrome secondary to clarithromycin: the first case and review of the literature","volume":"42","author":"Bilgin","year":"2014","journal-title":"Turk Kardiyol Dern Ars"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.23","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1186\/s13104-015-1072-5","article-title":"Kounis syndrome secondary to amoxicillin\/clavulanic acid administration: a case report and review of literature","volume":"8","author":"Ralapanawa","year":"2015","journal-title":"BMC Res Notes"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.24","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ijcard.2016.01.103","article-title":"Kounis syndrome induced by cefditoren pivoxil","volume":"207","author":"Barbarroja-Escudero","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.25","doi-asserted-by":"crossref","first-page":"444","DOI":"10.4103\/1658-354X.177329","article-title":"Kounis syndrome associated with amoxicillin\/clavulanic acid","volume":"10","author":"Shimi","year":"2016","journal-title":"Saudi J Anaesth"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.26","doi-asserted-by":"crossref","first-page":"335","DOI":"10.18176\/jiaci.0091","article-title":"Kounis syndrome after levofloxacin intake: a clinical report and cross-reactivity study","volume":"26","author":"Garc\u00eda N\u00fa\u00f1ez","year":"2016","journal-title":"J Investig Allergol Clin Immunol"},{"key":"2025082703255850000_2018.jan17_1.bcr-2017-222846.27","first-page":"466","article-title":"Interesting presentation of Kounis syndrome secondary to amoxicillin\/ clavulanate use: Coronary vasospasm and simultaneous appropriate implantable defibrillator shock","volume":"45","author":"Canpolat","year":"2017","journal-title":"Turk Kardiyol Dern Ars"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-222846","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T10:26:04Z","timestamp":1756290364000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-222846"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,17]]},"references-count":27,"alternative-id":["10.1136\/bcr-2017-222846"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-222846","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,17]]}}}