A 63-year-old man with diabetes and asymptomatic coronary artery disease developed refractory ventricular arrhythmia at 20 hours at rest after his second COVID-19 vaccine. Despite significant stenosis in the coronary arteries, there was no evidence of acute or old myocardial infarction, heart failure, myocarditis or structural abnormalities on post-mortem to account for the substrate for the fatal arrhythmia. The refractory and incessant nature of the ventricular fibrillation and post-mortem finding of a grossly elevated unexplained IgE level (in the absence of acute myocardial infarction) suggested the possibility of Kounis Syndrome or allergic acute coronary syndrome.
References
[1]
Marchand, G., Masoud, A.T. and Medi, S. (2023) Risk of All-Cause and Cardiac-Related Mortality after Vaccination against COVID-19: A Meta-Analysis of Self-Controlled Case Series Studies. Human Vaccines & Immunotherapeutics, 19, Article ID: 2230828. https://doi.org/10.1080/21645515.2023.2230828
[2]
Cocco, N., Leibundgut, G., Pelliccia, F., Cammalleri, V., Nusca, A., Mangiacapra, F., et al. (2023) Arrhythmias after COVID-19 Vaccination: Have We Left All Stones Unturned? International Journal of Molecular Sciences, 24, Article 10405. https://doi.org/10.3390/ijms241210405
[3]
Szczeklik, A., Sladek, K., Szczerba, A. and Dropinski, J. (1988) Serum Immunoglobulin E Response to Myocardial Infarction. Circulation, 77, 1245-1249. https://doi.org/10.1161/01.cir.77.6.1245
[4]
Kounis, N.G., Koniari, I., de Gregorio, C., Velissaris, D., Petalas, K., Brinia, A., et al. (2021) Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines, 9, Article 221. https://doi.org/10.3390/vaccines9030221
[5]
Özdemir, İ.H., Özlek, B., Özen, M.B., Gündüz, R. and Bayturan, Ö. (2021) Type 1 Kounis Syndrome Induced by Inactivated SARS-COV-2 Vaccine. TheJournalofEmergencyMedicine, 61, E71-E76. https://doi.org/10.1016/j.jemermed.2021.04.018
[6]
Ou, W., Wang, B., Zhang, G.M., Ding, L.C., Liu, Z.X., Wu, K.M., etal. (2023) Acute Myocardial Infarction after Inactivated COVID-19 Vaccination: A Case Report and Literature Review. FrontiersinCardiovascularMedicine, 10, Article 1123385. https://doi.org/10.3389/fcvm.2023.1123385
[7]
Osaba-Ruiz-de-Alegria, I., Ruiz-de-Galarreta-Beristain, M., Gutierrez-Niso, M., Ollo-Morales, P., De-la-Viuda-Camino, E. and Martel-Martin, C. (2023) Drug-Induced Kounis Syndrome: Latest Novelties. CurrentTreatmentOptionsinAllergy, 10, 301-318. https://doi.org/10.1007/s40521-023-00342-9
[8]
Kundumadam, S., Reddy, V., Mallikethi Reddy, S., Kathi, P. and Abidov, A. (2017) An Unusual Case of Recurrent Hypersensitivity Reaction Associated with Kounis-Like Acute Coronary Syndrome. CaseReportsinCardiology, 2017, Article ID 6421208. https://doi.org/10.1155/2017/6421208
[9]
Abrich, V.A. and Olshansky, B. (2022) Torsades De Pointes Following Vaccination for COVID-19. HeartRhythmCaseReports, 8, 393-397. https://doi.org/10.1016/j.hrcr.2022.04.003
