胃癌術後に発症したKounis 症候群の1 例

Kounis syndrome is defined as acute coronary syndrome (ACS) caused by an allergic reaction. We report a case of Kounis syndrome that occurred after gastrectomy. A 60-year-old man with no past medical history was diagnosed with gastric cancer and underwent robotic distal gastrectomy. Approximately 6 hours after the operation, bradycardia and hypotension suddenly emerged, with ST elevation in the electrocardiogram. ACS was suspected and coronary angiography was immediately performed. However, there were no obvious findings of coronary stenosis. In contrast, a reddish wheal appeared on the left knee before angiography, and thereafter rashes spread to both upper and lower limbs. Therefore, we diagnosed acute drug allergy followed by ACS, which is referred to as Kounis syndrome, and administered intravenous systemic steroids. After steroid therapy, blood pressure and heart rate both increased and there was no relapse of ACS symptoms or drug-induced allergy. The subsequent postoperative course was uneventful and the patient was discharged on postoperative day 23. This case indicates the need to consider drug-induced allergy when symptoms associated with ACS suddenly appear in patients with an apparently low risk of ACS.