Un syndrome coronarien aigu après une piqûre d'insecte rampant, un nouveau cas de syndrome de Kounis ?

Kounis syndrome is an acute coronary syndrome (ACS) occurring in a context of allergy. On January 2nd, 2014, on the island of La Reunion, a patient bitten in the foot by a crawling insect, has suffered of an ACS ST+ accompanied with additional arrhythmias and cardiorespiratory arrest. The patient received prehospital thrombolysis. Coronary angiography revealed the presence of a pre-existing coronary lesion. According to current knowledge, it could be a type 2 Kounis syndrome with dormant coronary lesions. This case report details the different types of Kounis syndrome, their pathophysiology and the specifics of their treatment. In front of this little known and difficult-to-diagnose syndrome, we emphasize the importance; in one hand, of a detailed questioning during the treatment of a chest pain in order to detect a possible contact with allergens, and in one another hand to perform a systematic ECG for each patient having an allergic reaction. In order to complete the assessment of this type of syndrome, it would be appropriate to make a quantitative analysis of anaphylaxis various markers.