title: Kounis syndrome secondary to amoxicillin/clavulanic acid administration: a case report and review of literature.
abstract: BACKGROUND
  Kounis syndrome is the concurrence of acute coronary syndromes with mast cells activation induced by hypersensitivity and anaphylactoid insults and is increasingly encountered in clinical practice. The main pathophysiological mechanism is vasospasm of the epicardial coronary arteries due to increased inflammatory mediators that are released during a hypersensitivity reaction.
  
  
  METHODS
  A 74-year -old Sinhalese man with diabetes mellitus was admitted with four day history of high fever with chills and rigors. His urine analysis and blood investigations revealed evidence of urinary tract infection. After excluding allergic conditions, he was given amoxicillin/clavulanic acid intravenously. About 20 minutes after the first dose he felt severe itching of body, nausea , dizziness and sever retrosternal chest pain. Urgent electrocardiogram was taken and it showed widespread ST segment elevations. He was treated for anaphylactic shock as well as acute coronary syndrome and was able to be discharged within a few days.
  
  
  CONCLUSIONS
  This case highlights the occurrence of acute coronary syndrome following drug induced anaphylaxis. Acute coronary syndrome of this nature may be completely atypical and overlooked. Kounis syndrome should be borne in mind in the event of anaphylactic episode wherein the electrocardiogram becomes essential.
authors.affiliation: Department of Medicine, Consultant Physician & Senior Lecturer, University of Peradeniya, Peradeniya, Sri Lanka. udayapralapanawa@yahoo.com.
authors.forename: Dissanayake Mudiyanselage Priyantha Udaya Kumara
authors.initials: DM
authors.lastname: Ralapanawa
authors.affiliation: Department of Medicine, Senior Professor in Medicine, Senior Consultant Physician, University of Peradeniya, Peradeniya, Sri Lanka. samkul@sltnet.lk.
authors.forename: Senanayake Abeysinghe Mudiyanselage
authors.initials: SA
authors.lastname: Kularatne
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced*; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000009:adverse effects*; D006801:Humans; D065093:beta-Lactamase Inhibitors / Q000009:adverse effects*
chemical_list: D065093:beta-Lactamase Inhibitors; D019980:Amoxicillin-Potassium Clavulanate Combination