Dangerous triplet: Polycystic ovary syndrome, oral contraceptives and Kounis syndrome

Abstract

Polycystic ovary syndrome is characterized by ovulatory dysfunction, androgen excess and polycystic ovaries and is associated with hypertension, diabetes, metabolic syndrome and cardiovascular events. Oral contraceptives constitute first-line treatment, particularly when symptomatic hyperandrogenism is present. However, these drugs are associated with cardiovascular events and hypersensitivity reactions that pose problem in differential diagnosis and therapy. We present a 14 year-old female with polycystic ovary syndrome taking oral contraceptive and suffering from recurrent coronary ischemic attacks with increased eosinophils, and troponin levels suggesting Kounis syndrome.

Keywords: Contraceptives; Eosinophils; Kounis syndrome; Polycystic ovary syndrome; Troponin

Core tip: The young lady in our case has had suffered from hyperandrogenism, oligomenorrhea, polycystic ovaries and while was receiving oral contraceptives she developed intermittent angina attacks not strictly related to her medication. The angina attacks associated with increased cardiac enzymes increased high sensitivity cardiac troponin, skin itching and electrocardiographic changes suggesting of myocardial ischemia. Eosinophils were raised but the coronary arteries were normal. The angina attacks disappeared with discontinuation of contraceptives. Such angina attacks associated with such clinical setting are attributed to disease itself, to oral contraceptives and/or to Kounis hypersensitivity coronary syndrome, namely a dangerous triplet.