Kounis syndrome and systemic mastocytosis: one step from elective lipoma resection to cardiac arrest
Notice bibliographique
Résumé
Kounis Syndrome manifests as unstable vasospastic or nonvasospastic angina and is caused by the release of inflammatory mediators following an allergic reaction. A variety of causes have been reported including antibiotics, general anesthetics, latex, insect stings, drug eluting stents, etc. To the best of our knowledge, Kounis syndrome in the setting of systemic mastocytosis has not been previously published. We describe the case of a 52- year- old male, who developed Kounis syndrome perioperatively and was subsequently diagnosed with systemic mastocytosis. Case report and literature review. A 52-year-old man was brought to operating room for an elective lipoma resection. Shortly after receiving cefazoline intravenously he developed generalized skin pruritus, flushing and dyspnea. He was treated with intravenous Benadryl and the lipoma site was infiltrated with combination of local anesthetics. He became increasingly agitated, hypoxic and the monitor showed development of ST elevation followed by ventricular fibrillation. The patient sustained a cardiac arrest and required full resuscitation. Return of circulation was achieved and ST segment elevation resolved within minutes of treatment with epinephrine. The procedure was abandoned. He was transferred to our hospital and subsequent angiography showed mild coronary artery disease. A transthoracic ECHO yielded a LVEF of 70% with no wall motion abnormality. His past medical history was remarkable for OSA, hypertension, dyslipidemia, obesity and allergic rhinitis. He reported allergies to insect stings and Terramycin. Blood work obtained one week after the episode showed an elevated baseline tryptase level of 29.3 ng/ml suggesting ongoing mast cell degranulation. He was assessed in Allergy Clinic 3 months later and reported a few years history of symptoms suggestive of Systemic Mastocytosis. His tryptase level was 31.2 ng/ml. RAST for penicillin allergens was negative. Skeletal survey was negative for lytic bone lesions. A working diagnosis of systemic mastocytosis was made and further confirmatory tests are pending. He was started on a combination H1 and H2 antihistamines, leukotriene antagonist and mast cell stabilizer. Kounis syndrome is one of the manifestations of anaphylactic reaction. This case report emphasizes the importance of recognizing Kounis syndrome in the setting of anaphylaxis. Effective management of Kounis syndrome should focus on the investigation and treatment of the acute coronary event as well as suppression of the allergic reaction. The flare of underlying systemic mastocytosis due to perioperative stress, rather than a true allergic reaction to cephalosporin, could have caused this reaction; however, further investigations are required.
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Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».