Kounis syndrome type I in a victim of cardiopulmonary arrest after hymenoptera sting

Abstract Kounis syndrome is a relatively rare entity in which allergic or hypersensitivity reactions (including anaphylaxis) coexist with acute coronary syndromes. We report a case of Kounis syndrome type I variant in a 51-year-old male, victim of an out-of-hospital cardiac arrest a few minutes after a hymenoptera sting. Ιn-hospital cardiopulmonary resuscitation was provided and return of spontaneous circulation was achieved. The post-resuscitation electrocardiogram revealed ST-segment elevation in leads II, III, aVF, and ST depression in leads V2 , V3 , and V4 . After administration of corticosteroids, antihistamines, nitrates, and a calcium-channel blocker the electrocardiogram rapidly returned to normal. There was no elevation in markers of myocardial necrosis and the coronary angiography revealed normal coronary arteries. According to the clinical course and the laboratory findings the diagnosis of Kounis syndrome type I variant was made. Only a few cases of Kounis syndrome in the setting of cardiopulmonary arrest have been published. We believe that in these cases, the recognition of the main underlying cause that lead to arrest (acute coronary syndrome or severe anaphylactic reaction) plays an important role in the choice of the most appropriate treatment for the patient. < Learning objective: Kounis syndrome is a rare clinical condition. However, every cardiologist should be capable of diagnosing it, because under specific circumstances it can be life-threatening.>