Arı Sokmasına Bağlı Subakut Stent Trombozu (Kounis Sendromu Tip 3)
Özet
Sınıf III anjina nedeniyle ilaç salınımlı stent implantasyonu uygulanan 69 yaşındaki erkek hastada, perkutan koroner girişimden 10 gün sonra arı sokmasına bağlı olarak gelişen bir subakut stent trombozu (Tip 3 Kounis Sendromu) vakası sunulmaktadır. Bilinen bir alerji öyküsü olmayan hasta, arı sokması sonrası yaygın döküntü ve kaşıntı şikayetiyle acil servise başvurmuş; burada uygulanan metilprednisolon ve feniramin tedavisinden yaklaşık 10 dakika sonra göğüs ağrısı yaşamaya başlamıştır. Yapılan elektrokardiyografide lateral derivasyonlarda ST segment yükselmesi tespit edilmiş ve acil koroner anjiyografide intermedier arter (İMA) stent içinde total oklüzyon gözlenmiştir. Tıkanıklık, NC balon müdahalesiyle başarılı bir şekilde açılarak tam açıklık sağlanmıştır. Yoğun bakım takibinde stabil seyreden hasta, medikal tedavisi düzenlenerek taburcu edilmiş ve sonraki kontrollerinde asemptomatik kalmıştır. Kounis sendromu, alerjik veya anafilaktik reaksiyonların tetiklediği akut koroner sendromları kapsar ve üç alt tipe ayrılır; Tip 3 varyantı doğrudan stent trombozu ile ilişkilidir. Sunulan vaka, klinisyenlerin alerji semptomlarına eşlik eden göğüs ağrısı varlığında, özellikle yakın zamanda stent öyküsü olan hastalarda nadir fakat ölümcül olabilen bu sendromu akılda tutmaları gerektiğini göstermektedir.
A 69-year-old male patient who developed subacute stent thrombosis (Type 3 Kounis Syndrome) triggered by a bee sting 10 days after receiving drug-eluting stent implantation for class III angina is presented. With no prior history of allergy, the patient admitted to the emergency department with widespread rash and itching following a bee sting. Approximately 10 minutes after receiving intravenous methylprednisolone and pheniramine, he experienced chest pain, and his ECG revealed ST-segment elevation in the lateral leads. Emergency coronary angiography demonstrated a total in-stent occlusion of the intermediate artery (IMA). The lesion was successfully treated with NC balloon angioplasty, restoring full patency. The patient remained stable during intensive care follow-up, was discharged with optimized medical therapy, and was asymptomatic at his 1- and 3-month follow-ups. Kounis syndrome represents acute coronary syndromes induced by inflammatory mediators during allergic or anaphylactic reactions, categorized into three distinct subtypes where Type 3 specifically involves coronary artery stent thrombosis. This case highlights that clinicians must consider Kounis syndrome when evaluating ischemic chest pain accompanied by allergic reactions, particularly in patients with a recent history of coronary stenting.
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