药物过敏导致Ⅰ型Kounis综合征1例

Type I Kounis syndrome caused by drug allergy:A case report

目的 探讨Kounis综合征的临床特征、诊疗要点及漏诊误诊原因。方法 对1例Ⅰ型Kounis综合征患者病历资料进行分析。结果 本病例为高龄,因社区获得性肺炎住院治疗,使用哌拉西林钠他唑巴坦钠抗感染治疗时发生迟发性过敏反应,抗过敏治疗好转,但出现胸闷、憋气症状。心电图提示下壁导联典型弓背抬高且呈动态改变;心肌酶正常;造影提示右冠状动脉痉挛,予硝酸甘油局部注射痉挛消失。结论 Kounis综合征是继发于过敏反应的冠脉痉挛,甚至引发急性心肌梗死的综合征。Kounis综合征在临床不常见,易造成漏诊、误诊,早期识别并妥善治疗是改善临床预后的关键。

Objective To explore the clinical features,diagnosis and treatment points,and causes of misdiagnosis and missed diagnosis of Kounis syndrome.Methods Medical records of one case of type I Kounis syndrome were retrospectively analyzed.Results The elderly patient was hospitalized due to community-acquired pneumonia,and presented delayed anaphylaxis during the anti-infection treatment of Piperacillin Sodium and Tazobactam Sodium.The anti-allergy treatment alleviated the delayed anaphylaxis,but the patient developed symptoms of chest tightness and suffocation.Electrocardiography(ECG)showed a typical pattern of ST elevation in leadⅡ,Ⅲand AVF,with dynamic changes.Myocardial enzyme levels were within the normal ranges.Coronary angiography showed the right coronary artery spasm,which was disappeared after a local injection of nitroglycerin.Conclusion Kounis syndrome is a syndrome of coronary artery spasm secondary to anaphylaxis,which may even cause acute myocardial infarction.It is a rare disorder that causes missed diagnosis and misdiagnosis.Early identification and proper treatment are the key points to improve the clinical prognosis.