Letters to the Editor: Acute coronary syndrome due to diclofenac potassium induced anaphylaxis: two Kounis syndrome variants in the same patient

Hypersensitivity reactions associated with underlying coronary artery disease (Kounis syndrome) are not rare, despite the fact that they are not frequently documented in the medical literature especially if induced by diclofenac potassium (DP) (1-3). We present a patient with ST-segment changes who suffered an anaphylactic reaction after oral administration of DP. A 74-year-old woman was referred to our emergency department approximately 30 minutes after taking oral DP. On admission, the patient was complaining of retrosternal chest pain and generalized erythema. She had no history of allergy. Her blood pressure was 60/35 mmHg. After the first evaluation, intravenous antihistaminic and 40 mg of prednisolone, saline and dopamine infusions at rate 10 mg/kg/minute over 1 hour were administered. Her electrocardiogram (ECG) recording showed 1 mm ST-elevation in inferior derivations and third degree atrioventricular (AV) block (Fig. 1a).