Case Report
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World J Cardiol. Oct 26, 2014; 6(10): 1131-1134
Published online Oct 26, 2014. doi: 10.4330/wjc.v6.i10.1131
Anaphylactic cardiovascular collapse during hemodialysis: Kounis syndrome in the dialysis room
Andreas Mazarakis, Konstantinos Bardousis, George Almpanis, Ira Mazaraki, Athanasios Ouzounis, Nicholas G Kounis
Andreas Mazarakis, Konstantinos Bardousis, George Almpanis, Ira Mazaraki, Athanasios Ouzounis, Department of Cardiology, “Saint Andrews” State General Hospital, 26504 Patras, Achaia, Greece
Nicholas G Kounis, Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, 26221 Patras, Achaia, Greece
Author contributions: Mazarakis A, Bardousis K, Almbanis G, Mazaraki I and Ouzounis A reviewed the literature, and helped to draft the manuscript; Kounis NG critically revised the manuscript; all authors have read and approved the final manuscript.
Correspondence to: Nicholas G Kounis, MD, PhD, FESC, FACC, FAHA, Department of Medical Sciences, Southwestern Greece Highest Institute of Education and Technology, Queen Olgas Square, 7 Aratou Street, 2622 Patras, Achaia, Greece. ngkounis@otenet.gr
Telephone: +30-26-10279579 Fax: +30-26-10279579
Received: June 1, 2014
Revised: July 12, 2014
Accepted: August 27, 2014
Published online: October 26, 2014
Processing time: 157 Days and 4.7 Hours
Abstract

Kounis syndrome seems to be not a rare disease but a rarely diagnosed disorder. Multiple causes can join forces and trigger the development of this syndrome. We report the first case of Kounis syndrome manifesting as myocardial infarction with cardiovascular collapse that occurred in the dialysis room following an allergic reaction. The dialysis apparatus material of polyurethane, polyamide, polycarbonate, silicon rubber and polypropylene were incriminated causes. Physicians should be aware of the causality and existence of this disorder in order to achieve early and correct diagnosis and apply the appropriate therapeutic measures.

Keywords: Anaphylactic shock; Dialysis room; Dialysis apparatus; Kounis syndrome; Mast cell degranulation

Core tip: This is the first report of Kounis syndrome occurring in the dialysis room in a patient using a new dialysis machine. The apparatus components acting as allergens are incriminated since subsequent hemodialysis sessions with the apparatus used before the anaphylactic reaction were without any sequelae. Materials such as polyurethane, polyamide, polycarbonate, silicon rubber and polypropylene acting as allergens might prove risky in sensitive patients during hemodialysis. Atopic patients should be always interrogated about allergies and patch testing concerning the apparatus components should be performed in such patients.