BMJ Case Reports 2017; doi:10.1136/bcr-2017-221256
  • Rare disease

Wasp sting induced STEMI with complete coronary artery occlusion: a case of Kounis syndrome

  1. Gavin Galasko2
  1. 1Medical student, Blackpool Victoria Hospital, Blackpool, UK
  2. 2Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
  3. 3General Practice, Viran Medical Centre, Preston, UK
  1. Correspondence to Benjamin Cross, bencross142{at}
  • Accepted 23 August 2017
  • Published 7 September 2017


A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. This patient also has a history of atopy giving a predisposition for developing IgE-mediated allergic reactions. Hymenoptera stings can be severe in atopic individuals and anaphylaxis may ensue. However, it is a rare cause of myocardial infarction (MI) (Kounis syndrome). Multiple wasp stings in the past may have contributed to sensitisation. Kounis syndrome is a rare clinical manifestation which should remain in the minds of physicians, especially with younger patients with no history of ischaemic heart disease or few risk factors.


  • Contributors GG was the consultant responsible for the care of the patient, drafted and revised the paper and acts as the guarantor. BC wrote, drafted and revised the paper. TRC and MH drafted and revised the paper.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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