Kounis Syndrome - A Retrospective Post-Mortem Study

Kounis syndrome is defined as acute coronary syndrome caused by an allergic reaction or a strong immune reaction to a drug or any other substance. Mast cell activation and release of inflammatory cytokines from the reaction leads to spasm of the artery leading to the heart muscle or a plaque breaking free and blocking that artery. In this study, all the suspected cases of drug anaphylaxis which are autopsied during the period January 2011 to December 2014 were analyzed at the Department of Forensic Medicine & Toxicology, AIMS, BG Nagar, and Karnataka. The incidence, age and sex wise distribution of cases and histopathology reports were analyzed. In 6 cases histo-pathology report shows 80 to 90% block in coronaries with ruptured atheromatous plaques, cardiac muscle hypertrophy in heart, atheromatous plaques in aorta and hemorrhagic infarct, areas of intra-alveolar hemorrhage, pulmonary edema, focal areas shows histiocytes, cholesterol bodies. On examination of skin in and around the injection site using color tests, thin layer chromatography, high performance thin layer chromatographic methods at regional forensic science laboratory, 2 cases have responded for diclofenac compound and 3 cases have responded for traces of ceftriaxone compound and nothing was detected in remaining 2 cases.