title: Kounis syndrome or allergic coronary vasospasm in a two-year-old.
abstract: Kounis syndrome is coronary vasospasm because of mast cell degranulation in the context of an allergic reaction. The syndrome has known associations with several drugs used during anesthesia, including rocuronium and isoflurane. In this case report, we discuss a 2-year-old patient who developed signs and symptoms of an acute coronary syndrome soon after anesthesia for atrial septal defect repair. A diagnostic angiography after the episode revealed diffusely small coronary arteries. Subsequent angiography after clinical improvement showed essentially normal coronary anatomy. We report the clinical course of this patient and postulate that Kounis syndrome was the explanation for his transient coronary vasospasm. To date, this is the youngest known patient with reported Kounis syndrome.
authors.affiliation: University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh of UPMC, 45th and Penn Avenue, Pittsburgh, PA 15201, USA.
authors.forename: Brodie
authors.initials: B
authors.lastname: Parent
authors.forename: Peter
authors.initials: P
authors.lastname: Wearden
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Kounis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Chrysostomou
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D000732:Androstanols / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D002675:Child, Preschool; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004562:Electrocardiography; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D007530:Isoflurane / Q000009:adverse effects*; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D000077123:Rocuronium; D016896:Treatment Outcome
chemical_list: D000732:Androstanols; D018685:Anesthetics, Inhalation; D003473:Neuromuscular Nondepolarizing Agents; D007530:Isoflurane; D000077123:Rocuronium