title: A case of Kounis syndrome after a hornet sting and literature review.
abstract: BACKGROUND
  Acute coronary syndrome after hymenoptera stings or exposure to environment toxins is referred to as the Kounis syndrome or allergic myocardial ischaemia with or without infarction. We report a case of hornet (Vespa affinis) sting causing Kounis syndrome in Sri Lanka and present a review of literature.
  
  
  METHODS
  A 60-year -old female with diabetes mellitus and known allergy to bee venom was stung by a hornet on the right hand. Within 30 minutes she developed hypotension and wide spread T wave inversion in the 12 leads ECG that remained unchanged about 5 hours and reversed back to normal.
  
  
  CONCLUSIONS
  Hymenoptera stings can induce acute coronary syndrome either by direct effect of venom constituents on the coronary endothelium or through inflammatory mediators induced allergic reaction on coronary vasculature. Early recognition of Kounis syndrome is needed in hornet stings to implement necessary treatments.
authors.affiliation: Department of Medicine, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.
authors.forename: Dissanayake Mudiyanselage Priyantha Udaya Kumara
authors.initials: DM
authors.lastname: Ralapanawa
authors.forename: Senanayake Abeysinghe Mudiyanselage
authors.initials: SA
authors.lastname: Kularatne
mesh_terms: D000818:Animals; D001733:Bites and Stings / Q000150:complications*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology* / Q000503:physiopathology; D013577:Syndrome; D014863:Wasps