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Revista Española de Anestesiología y Reanimación (English Edition) Can an antibiotic trigger a heart attack? Kounis syndrome induced by intraoperat...
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Vol. 73. Issue 7.
(August - September 2026)
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Vol. 73. Issue 7.
(August - September 2026)
Case report

Can an antibiotic trigger a heart attack? Kounis syndrome induced by intraoperative amoxicillin allergy: a case report

¿Puede un antibiótico provocar un síndrome coronario agudo Síndrome de Kounis inducido por alergia intraoperatoria a la amoxicilina: un caso clínico.
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M. Bernaolaa,
Corresponding author
mbernaola91@gmail.com

Corresponding author.
, A. Gagob, A. Umpiérreza, López-Soberónc, N.G. Kounisd
a Allergy Department, Hospital Central de la Defensa “Gómez Ulla”, Madrid, Spain
b Anesthesiology Department, Hospital Central de la Defensa “Gómez Ulla”, Madrid, Spain
c Cardiology Department, Hospital Central de la Defensa “Gómez Ulla”, Madrid, Spain
d Department of Medicine, Division of Cardiology, University Hospital of Patras, Greece
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Abstract

Kounis syndrome (KS) is an acute coronary syndrome triggered by mast cell degranulation in response to allergic or hypersensitivity reactions. Drug-induced KS, particularly due to antibiotics like amoxicillin, represents a severe and potentially life-threatening condition. This review aims to analyze the pathophysiology, clinical manifestations, diagnostic approaches, and management strategies of KS induced by amoxicillin allergy, with a focus on recent literature and emerging therapeutic insights.

Keywords:
Kounis syndrome
Amoxicillin
Multidisciplinary management
Acute coronary syndrome
Beta-Lactam antibiotic
Epinephrine
Inflammatory cells
Mediators
Anaphylaxis
Chest pain
Resumen

El síndrome de Kounis (SK) es un síndrome coronario agudo desencadenado por la degranulación de mastocitos en respuesta a reacciones alérgicas o de hipersensibilidad. El SK inducido por fármacos, particularmente por antibióticos como la amoxicilina, representa una entidad clínica grave y potencialmente mortal. La presente revisión tiene como objetivo analizar la fisiopatología, las manifestaciones clínicas, el enfoque diagnóstico y las estrategias de manejo del SK inducido por alergia a la amoxicilina, con especial atención a la literatura reciente y a los avances terapéuticos emergentes.

Palabras clave:
Síndrome de Kounis
Amoxicilina
Manejo multidisciplinario
Síndrome coronario agudo
Antibióticos betalactámicos
Adrenalina
Células inflamatorias
Mediadores proinflamatorios
Anafilaxia
Dolor torácico

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