title: Myocardial infarction associated with eosinophilia and plasma extravasation at multiple sites. A variant of Kounis syndrome.
abstract: Myocardial infarction occurring during the course of type I hypersensitivity constitutes Kounis syndrome. We report a case of a 38-year-old man who presented with anterior ST elevation myocardial infarction and peripheral blood eosinophilia. He had rhinitis and malaise for several days prior to presentation. There was no urticarial rash or pruritus to suggest hypersensitivity. Coronary angiogram revealed only mild plaque disease. Blood investigations revealed moderate eosinophilia and elevated IgE levels. CT of the thorax revealed fluid extravasation at multiple sites. Screening for a possible secondary cause for eosinophilia revealed hypersensitivity to multiple antigens. A diagnosis of Kounis syndrome was made. Within days of starting steroids and antihistamines, the patient's eosinophil count returned to normal with improvement of clinical picture. This case differs from classical Kounis syndrome as there was no acute allergic reaction (except atopic rhinitis). Fluid extravasation at multiple sites has not been described in previous cases.
authors.affiliation: Department of Cardiology, Sri Jayawardenapura Teaching Hospital, Colombo, Sri Lanka.
authors.forename: Mudalige Don Vajira Malin
authors.initials: MD
authors.lastname: Gunawardena
authors.affiliation: Department of Medicine, Dr Neville Fernando Teaching Hospital, Malabe, Sri Lanka.
authors.forename: Anura
authors.initials: A
authors.lastname: Weerasinghe
authors.affiliation: Department of Cardiology, Sri Jayawardenapura Teaching Hospital, Colombo, Sri Lanka.
authors.forename: Jagath
authors.initials: J
authors.lastname: Herath
authors.affiliation: Department of Cardiology, Sri Jayawardenapura Teaching Hospital, Colombo, Sri Lanka.
authors.forename: Naomali
authors.initials: N
authors.lastname: Amarasena
mesh_terms: D000328:Adult; D018926:Anti-Allergic Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004802:Eosinophilia / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007073:Immunoglobulin E / Q000097:blood; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D010949:Plasma; D065631:Rhinitis, Allergic / Q000150:complications; D013577:Syndrome; D016593:Terfenadine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D007073:Immunoglobulin E; D016593:Terfenadine; C093230:fexofenadine; D008775:Methylprednisolone