Recurrent diclofenac-induced acute myocardial infarction: An interesting case with wandering ST-segment elevation

Abstract

Introduction: Allergic acute myocardial infarction with ST-segment elevation is rare, and vasoconstrictor mediators released from mast cells are responsible for its pathogenesis. Several medications have been reported to lead to acute myocardial infarction with ST-segment elevation, as a part of systemic allergic reactions and this entity is known as Kounis syndrome (KS). Case presentation: We presented a patient with recurrent KS who had no allergic reactions, except coronary spasm after parenteral diclofenac administration. First, she experienced anterior myocardial infarction with ST-segment elevation after administration of diclofenac 2 years ago. The second presentation was acute inferior-posterior myocardial infarction with ST-segment elevation with atrioventricular complete block leading to cardiogenic shock. She had no significant coronary stenosis responsible for each myocardial infarction with ST-segment elevation. However, she had a catheter-induced coronary spasm of non-dominant right coronary artery. She was considered to have a recurrent allergic myocardial infarction with ST-segment elevation due to parenteral diclofenac usage and treated with a calcium antagonist, statin, and dual antiplatelet agent. Discussion: KS can manifest as same as acute coronary syndrome. All drugs or any allergen can cause this event.KS had three variants but In all three conditions, treatment is antithrombotic or vasodilatator regime. Conclusion: As atherosclerosis events on coronary, allergic coronary events also may recurs. However, unlike the literature, our case is differentiated by recurrence of similar events in different coronary vessels.