The conundrum of hypersensitivity cardiac disease: Hypersensitivity myocarditis, acute hypersensitivity coronary syndrome (Kounis Syndrome) or both?

Hypersensitivity or allergic inflammatory processes can affect the cardiac structures during allergic insults. The myocardium, the conduction system and the coronary arteries can be the targets of these insults resulting in Kounis syndrome (hypersensitivity coronary syndrome) or hypersensitivity myocarditis. Kounis syndrome and hypersensitivity myocarditis can be clinically indistinguishable and masquerade each other. Simultaneous occurrence of both entities has not been reported. We report on a patient who presented with signs and symptoms of type I variant of Kounis syndrome but cardiac magnetic resonance imaging showed that he had hypersensitivity myocarditis.