A Rare Clinic Related to Paclitaxel Use: Type 2 Kounis Syndrome

Authors : Baycan Kus, Mehmet Uzun, Necmi Baykan, Harun Çifci, Merve İrem Atıcı

Pages : 123-129

View : 34 | Download : 41

Publication Date : 2025-04-30

Article Type : Other Papers

Abstract :Paclitaxel is a member of the taxane class of chemotherapy medications and is utilized in the treatment of ovarian, breast, advanced non-small cell lung cancer, and Kaposi\\\'s Sarcoma associated with AIDS. Hypersensitivity reactions are relatively common and may range from mild clinical manifestations to severe, treatment-resistant, and even fatal outcomes. Approximately 30% of patients receiving taxane-based chemotherapeutic agents experience such reactions. Proposed pathophysiological mechanisms include IgE-mediated anaphylaxis—characterized by elevated serum tryptase levels—direct activation of mast cells and/or basophils, and the involvement of the complement cascade. Kounis syndrome is an acute coronary condition that arises during allergic or anaphylactic reactions. In the pathogenesis of Kounis syndrome, a variety of inflammatory mediators are thought to be involved, including proteases, tryptase, arachidonic acid metabolites, platelet-activating factor, as well as various cytokines and chemokines released during mast cell activation. The incidence in patients undergoing an allergic, hypersensitive, anaphylactic, or anaphylactoid reaction ranges from 1.1% to 3.4%. The most common heart complaint during application is chest pain (incidence: 86.6%). Diagnosing Kounis syndrome in the emergency department can be challenging due to the variety of clinical symptoms. It should rely on the presence of cardiovascular, allergic, or anaphylactic symptoms and signs, along with supporting evidence from laboratory tests, electrocardiograms, echocardiograms, and angiograms. In this report, we present a case of anaphylaxis while receiving paclitaxel treatment for lung malignancy in the chemotherapy unit and the diagnosis of Type 2 Kounis syndrome was established in the emergency department. Our case represents Type 2 Kounis syndrome because of ST segment elevation in inferior leads and occlusion in coronary angiography. Previously reported cases in the literature were Type 1 Kounis syndrome and our case is Type 2 Kounis syndrome. Therefore, this case report is a rare case report. Our case is a rare case report because the culprit vessel of inferior wall ST segment elevation was not the right coronary artery but the circumflex artery.
Keywords : Akciğer Adenokarsinomu, Anaflaksi, Kounis Sendromu, Paklitaksel