药物过敏导致I型Kounis综合征1例

doi:10.3969/j.issn.1004-583X.2023.10.011

临床荟萃 ›› 2023, Vol. 38 ›› Issue (10): 922-925.doi: 10.3969/j.issn.1004-583X.2023.10.011

药物过敏导致I型Kounis综合征1例

杨昌林, 曹淑风(), 乔莲, 赵慧敏

中国人民解放军联勤保障部队第970医院全科医学科,山东烟台 264000

收稿日期:2023-05-13 出版日期:2023-10-20 发布日期:2024-01-03
通讯作者: 曹淑风 E-mail:csf1004@126.com

Type I Kounis syndrome caused by drug allergy: A case report

Yang Changlin, Cao Shufeng(), Qiao Lian, Zhao Huimin

Department of General Practice,970 Hospital of the PLA JLSF,Yantai 264000,China

Received:2023-05-13 Online:2023-10-20 Published:2024-01-03
Contact: Cao Shufeng E-mail:csf1004@126.com

摘要/Abstract

摘要： 目的探讨Kounis综合征的临床特征、诊疗要点及漏诊误诊原因。方法对1例I型Kounis综合征患者病历资料进行分析。结果本病例为高龄,因社区获得性肺炎住院治疗,使用哌拉西林钠他唑巴坦钠抗感染治疗时发生迟发性过敏反应,抗过敏治疗好转,但出现胸闷、憋气症状。心电图提示下壁导联典型弓背抬高且呈动态改变;心肌酶正常;造影提示右冠状动脉痉挛,予硝酸甘油局部注射痉挛消失。结论 Kounis综合征是继发于过敏反应的冠脉痉挛,甚至引发急性心肌梗死的综合征。Kounis综合征在临床不常见,易造成漏诊、误诊, 早期识别并妥善治疗是改善临床预后的关键。

关键词: Kounis综合征, 哌拉西林, 他唑巴坦复方合剂, 药物过敏, 冠状血管痉挛

Abstract: Objective To explore the clinical features, diagnosis and treatment points, and causes of misdiagnosis and missed diagnosis of Kounis syndrome. Methods Medical records of one case of type I Kounis syndrome were retrospectively analyzed. Results The elderly patient was hospitalized due to community-acquired pneumonia, and presented delayed anaphylaxis during the anti-infection treatment of Piperacillin Sodium and Tazobactam Sodium. The anti-allergy treatment alleviated the delayed anaphylaxis, but the patient developed symptoms of chest tightness and suffocation. Electrocardiography (ECG) showed a typical pattern of ST elevation in lead Ⅱ, Ⅲ and AVF, with dynamic changes. Myocardial enzyme levels were within the normal ranges. Coronary angiography showed the right coronary artery spasm, which was disappeared after a local injection of nitroglycerin. Conclusion Kounis syndrome is a syndrome of coronary artery spasm secondary to anaphylaxis, which may even cause acute myocardial infarction. It is a rare disorder that causes missed diagnosis and misdiagnosis. Early identification and proper treatment are the key points to improve the clinical prognosis.

Key words: Kounis syndrome, piperacillin, tazobactam drug combination, drug hypersensitivity, coronary vasospasm

中图分类号:

R541.4

杨昌林, 曹淑风, 乔莲, 赵慧敏. 药物过敏导致I型Kounis综合征1例[J]. 临床荟萃, 2023, 38(10): 922-925.

Yang Changlin, Cao Shufeng, Qiao Lian, Zhao Huimin. Type I Kounis syndrome caused by drug allergy: A case report[J]. Clinical Focus, 2023, 38(10): 922-925.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2023.10.011

https://huicui.hebmu.edu.cn/CN/Y2023/V38/I10/922

图/表 3

图1 胸闷憋气发作时心电图表现

Fig. 1 ECG during chest tightness and suffocation

图2 右冠脉痉挛及注射硝酸甘油后痉挛消失

Fig. 2 Right coronary artery spasm and spasm disappeared after injection of nitroglycerin

图3 胸闷憋气缓解后心电图表现

Fig. 3 ECG after relief of chest tightness and suffocation

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药物过敏导致I型Kounis综合征1例

Type I Kounis syndrome caused by drug allergy: A case report

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