Vol.73 No.2 March 2025

Case Report

Tazobactam/piperacillin-induced Kounis syndrome, with similar symptoms also triggered by therapeutic administration of methylprednisolone: A case report

Satoshi Anai^1）, Kohei Isa^1）, Shigeki Chinen^1）, Shiho Ueno^1）, Yoko Sato^1） and Tsuyoshi Matsumoto^1）

¹⁾Division of Respiratory Medicine, Yuuai Medical Center, 50-5 Yone, Tomishiro city, Okinawa, Japan

要旨

　We report a rare case of Kounis syndrome induced by tazobactam/piperacillin (TAZ/PIPC) in a patient who had received multiple prior administrations of the same antibiotic for bacterial pneumonia without event. Notably, the patient also exhibited similar symptoms following administration of methylprednisolone for the treatment of anaphylaxis. The clinical course of this rare case was challenging, yet insightful. A 70-year-old male patient with rheumatoid arthritis and asthma-chronic obstructive disease overlap syndrome (ACOS) developed anaphylactic shock and coronary vasospasm shortly after receiving an injection of TAZ/PIPC. A 12-lead electrocardiogram (ECG) showed marked ST elevation in leads II, III and aVF, and the patient was intubated and initiated on mechanical ventilation. Coronary angiography revealed no obvious stenosis of the coronary arteries. The ST-segment elevation on the ECG also normalized. Based on the findings, the patient was diagnosed as having suffered coronary anaphylaxis (Kounis syndrome type I) and stabilized with epinephrine, norepinephrine, and fluid boluses. Furthermore, the patient also developed anaphylactic shock and ST-segment elevation on the ECG following methylprednisolone administration, which resolved after the drug was switched to betamethasone. This case highlights the importance of rapid diagnosis and balancing treatment for both anaphylaxis and acute coronary syndromes in these patients.

Key word

Kounis syndrome, anaphylaxis, coronary vasospasm, tazobactam/piperacillin, methylprednisolone

受付日

2024年10月29日

受理日

2024年12月13日

日化療会誌 73 (2): 163-168, 2025