SHM Converge Scientific Abstract ePoster Gallery-A Unique Case of Kounis Syndrome Secondary to an Allergic Reaction to Rifampin

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This case report describes a likely first documented instance of Kounis syndrome triggered by rifampin allergy. An 81-year-old man with known coronary artery disease and pulmonary tuberculosis developed fever, diffuse pruritic rash, dyspnea, and chest discomfort shortly after starting standard TB therapy. Initial evaluation showed rising troponins and ischemic ECG changes, so he was treated as a presumed type I non-ST elevation myocardial infarction.<br /><br />During stepwise reintroduction of his TB medications, he tolerated isoniazid, pyrazinamide, and ethambutol, but after receiving rifampin again he rapidly developed urticaria, hypotension, dyspnea, and chest pain identical to his earlier symptoms. This strongly implicated rifampin as the trigger. He also had eosinophilia and was treated for anaphylaxis. Rifampin was stopped and replaced with moxifloxacin. Later cardiac catheterization showed severe multivessel obstructive coronary disease.<br /><br />The report explains that rifampin can rarely cause IgE-mediated anaphylaxis, especially after repeat exposure and sensitization. Kounis syndrome is an allergic acute coronary syndrome in which mast cell activation during an allergic reaction promotes plaque destabilization and myocardial infarction. In this patient, the authors believe rifampin caused anaphylaxis, which then precipitated coronary plaque rupture and MI in the setting of pre-existing CAD.<br /><br />The key clinical lesson is that Kounis syndrome should be considered in patients with chest pain or myocardial infarction symptoms accompanied by allergic features, particularly after a new drug exposure. The case also highlights the important role of hospital medicine in coordinating care across cardiology, infectious disease, and allergy-related diagnostic concerns.

Asset Subtitle

Harnadar Anand

Meta Tag

Author List Harnadar Anand, Sean Kenmore, Stephanie Cleverdon

Category Clinical Vignettes

Concept Kounis Syndrome

Concept Allergic Reaction

Concept Acute Coronary Syndrome

Concept Chest Pain

Concept Electrocardiogram Change

Distinguished Non-Finalist

Presenter Organization University of California, San Diego

Presenting Author Harnadar Anand

Track Adult

Keywords

Kounis syndrome

rifampin allergy

anaphylaxis

myocardial infarction

coronary artery disease

tuberculosis therapy

allergic acute coronary syndrome

troponin elevation

urticaria

mast cell activation

Kounis Syndrome

Allergic Reaction

Acute Coronary Syndrome

Chest Pain

Electrocardiogram Change