Abstract
Kounis syndrome (KS), characterized by the simultaneous occurrence of acute coronary syndrome (ACS) and allergic reactions, can be triggered by a range of factors and drugs. We report on the case of a patient who arrived at our emergency department (ED) with symptoms of an allergic reaction after taking moxifloxacin and deflazacort orally. In the ED, the patient experienced a 5-minute episode of oppressive chest pain. A 12-lead electrocardiogram (ECG) was registered, and elevated troponin levels were detected in the blood, suggesting myocardial damage. The patient was admitted to the internal medicine department for observation, and a second 12-lead ECG demonstrated a significant variation in the repolarization pattern. The day after, a coronary angiography revealed no significant stenosis, thus supporting, along with elevated serum tryptase levels, the diagnosis of KS. This case report highlights two potential triggers for KS and emphasizes the critical importance of early recognition and prompt treatment of KS. LEARNING POINTS: Kounis syndrome can be triggered by moxifloxacin and/or deflazacort. This case report documents the onset of Kounis syndrome following the administration of moxifloxacin and deflazacort.Diagnosing and treating Kounis syndrome can be challenging. Its diverse triggers and clinical manifestations complicate accurate diagnosis. Effective treatment involves addressing both cardiac and allergic symptoms, with the understanding that medications used for cardiac issues may exacerbate allergic reactions, and vice versa.Nonspecific electrocardiogram (ECG) alterations should not be underestimated. In the context of an allergic reaction, ECG alterations, including nonspecific ones, might be an early warning sign.