ArticleThe American journal of case reports2026
Anterior ST-Segment Elevation Myocardial Infarction Shortly After Cefaclor Exposure: A Case Report Highlighting Kounis Syndrome as a Differential Diagnosis.
Article in The American journal of case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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Who cites it
1 citing paper in PubMed.
- Kounis Syndrome in the Modern Era: A Comprehensive Review of Allergic Acute Coronary Syndromes.Journal of clinical medicine · 2026Review
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4 authors.
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Abstract
BACKGROUND Kounis syndrome is an acute coronary syndrome associated with allergic or hypersensitivity reactions, but establishment of causality is difficult when objective allergy-related tests are unavailable during emergency treatment. This report describes anterior ST-segment elevation myocardial infarction (STEMI) occurring shortly after cefaclor exposure and highlights the diagnostic limitations of attributing the event to hypersensitivity in routine emergency clinical practice. CASE REPORT A 61-year-old man with a history of positive penicillin skin testing, but no prior penicillin administration, developed severe chest pain approximately 1 hour after self-administration of oral cefaclor for respiratory symptoms. He had no rash, urticaria, wheezing, angioedema, oropharyngeal edema, hypotension, or dyspnea; no prehospital antihistamines, corticosteroids, or epinephrine were administered. Electrocardiography showed ST-segment elevation in V2 to V6, and emergency coronary angiography demonstrated 90% proximal left anterior descending artery stenosis with Thrombolysis in Myocardial Infarction grade II flow. Primary percutaneous coronary intervention restored grade III flow and relieved symptoms. High-sensitivity cardiac troponin I increased from 0.57 to 1.10 ng/mL and peaked at 3.92 ng/mL at 15 hours. Serum tryptase, histamine, total and specific IgE, and intracoronary imaging were not obtained. The Naranjo score was 2, indicating a possible adverse drug reaction. CONCLUSIONS The temporal association prompted consideration of Kounis syndrome, but severe fixed coronary stenosis makes coincidental plaque-related STEMI a major alternative diagnosis. Early allergy biomarker sampling and careful causal assessment are important in similar cases.
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