{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T05:26:41Z","timestamp":1766467601559,"version":"build-2065373602"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Kounis syndrome (KS) is an acute coronary syndrome triggered by hypersensitivity reactions and is often underrecognized in clinical practice. This report describes a case of iodixanol-induced KS that was refractory to standard emergency medications but successfully managed with an intra-aortic balloon pump (IABP), along with a review of similar published cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>A 77-year-old woman with a history of chest pain underwent coronary angiography with iodixanol. During the procedure, she developed progressive bradycardia, hypotension, and convulsions. Despite immediate cardiopulmonary resuscitation and the administration of emergency medications, hypotension persisted. Hemodynamic stability was rapidly achieved following IABP implantation, with complete resolution of symptoms and no complications. This case represents the first reported instance of iodixanol-induced KS that was unresponsive to conventional vasoactive drugs and required IABP for stabilization. A review of the literature identified four prior cases of iodixanol-induced KS, all of which were successfully managed with medical therapy alone, highlighting the unique severity and therapeutic challenge of the present case.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first reported use of IABP for iodixanol-induced KS, suggesting its potential role in refractory cases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1652423","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T05:27:09Z","timestamp":1759987629000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Successful treatment of iodixanol-induced type II Kounis syndrome with an intra-aortic balloon pump: a case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Naiju","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junran","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhenjie","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tianping","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1016\/j.mayocp.2012.01.012","article-title":"Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: a primer for the non-radiologist","volume":"87","author":"Pasternak","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"B2","doi-asserted-by":"publisher","first-page":"449","DOI":"10.3390\/jcdd10110449","article-title":"Efficacy and safety of iodixanol in computed coronary tomographic angiography and cardiac catheterization","volume":"10","author":"Budoff","year":"2023","journal-title":"J Cardiovasc Dev Dis"},{"key":"B3","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.iac.2022.10.010","article-title":"Allergic acute coronary syndrome-kounis syndrome","volume":"43","author":"Alblaihed","year":"2023","journal-title":"Immunol Allergy Clin North Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1007\/s40521-023-00342-9","article-title":"Drug-induced Kounis syndrome: latest novelties","volume":"10","author":"Ollo-Morales","year":"2023","journal-title":"Curr Treat Options Allergy"},{"key":"B5","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":"B6","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":"B7","doi-asserted-by":"publisher","first-page":"239","DOI":"10.2147\/JAA.S410451","article-title":"Erratum: anaphylaxis following contrast-enhanced CT with iodixanol: a case report and literature review [corrigendum]","volume":"16","author":"Qiu","year":"2023","journal-title":"J Asthma Allergy"},{"key":"B8","doi-asserted-by":"publisher","first-page":"133057","DOI":"10.1016\/j.ijcard.2025.133057","article-title":"Formal case-definition for Kounis syndrome","volume":"425","author":"Yale","year":"2025","journal-title":"Int J Cardiol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.clinthera.2013.02.022","article-title":"Coronary hypersensitivity disorder: the Kounis syndrome","volume":"35","author":"Kounis","year":"2013","journal-title":"Clin Ther"},{"key":"B10","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.ijcard.2021.04.018","article-title":"Kounis syndrome: towards a new classification","volume":"341","author":"Giovannini","year":"2021","journal-title":"Int J Cardiol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"132606","DOI":"10.1016\/j.ijcard.2024.132606","article-title":"Clinical characteristics, management, diagnostic findings, and various etiologies of patients with Kounis syndrome. 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