title: A Male Patient with Syncope, Anaphylaxis, and ST-Elevation: Hepatic and Cardiac Echinococcosis Presenting with Kounis Syndrome.
abstract: BACKGROUND
  Approximately 1% of emergency department (ED) visits are due to anaphylaxis. Symptoms can include skin rash, facial and laryngeal edema, dyspnea, vomiting, hypotension, and shock. A transient loss of consciousness can also be a manifestation of anaphylaxis. A variety of electrocardiographic changes due to anaphylaxis have been described for Kounis syndrome, also known as allergic angina.
  
  
  METHODS
  Here we describe the case of a male patient presenting at an ED with syncope, anaphylactic shock, and ST-segment elevation on electrocardiogram (ECG). The diagnostic workup led to the diagnosis of ruptured hepatic echinococcal cyst complicated by anaphylactic shock and syncope. ECG alterations were a manifestation of anaphylaxis, as defined by the type I Kounis syndrome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Kounis syndrome represents an underestimated disease. Its prompt diagnosis in an ED has important clinical and therapeutic implications, such as modifications in the anaphylaxis treatment protocol, that is, adrenaline should be avoided because it could worsen vasospasm and myocardial ischemia.
authors: Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Antonio
authors: A
authors: Mirijello
authors: Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Gaetano
authors: G
authors: Pepe
authors: Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Patrizio
authors: P
authors: Zampiello
authors: Department of Cardiovascular Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Giovanni Marco
authors: GM
authors: Criconia
authors: Department of Anesthesiology and Intensive Care, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Angela
authors: A
authors: Mendola
authors: Department of Emergency Medicine, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Foggia, Italy.
authors: Antonio
authors: A
authors: Manfrini
mesh_terms: D000707:Anaphylaxis / Q000209:etiology* / Q000503:physiopathology*; D004444:Echinococcosis, Hepatic / Q000150:complications* / Q000000981:diagnostic imaging; D004562:Electrocardiography; D006801:Humans; D008297:Male; D012422:Rupture, Spontaneous / Q000150:complications; D013575:Syncope / Q000209:etiology; D013577:Syndrome; D055815:Young Adult
keywords: Kounis syndrome; anaphylactic shock; non-ischemic ST-elevation; syncope