Intravenous Contrast-Induced Kounis Syndrome Presenting as Unstable Monomorphic Ventricular Tachycardia: A Rare Case Report

Abstract

Kounis syndrome (KS) is defined as the occurrence of acute coronary syndromes in the setting of hypersensitivity reactions mediated by mast-cell activation. Various triggers have been implicated, including iodinated contrast agents. We report a 65-year-old woman who developed hypotension and unstable monomorphic ventricular tachycardia approximately 30 minutes after administration of iodinated contrast for computed tomography of the abdomen. Cardiac biomarkers were elevated, and echocardiography demonstrated regional wall motion abnormalities with reduced ejection fraction. Coronary angiography revealed non-obstructive coronary artery disease. The temporal relationship between contrast exposure and myocardial injury supported a diagnosis of contrast-induced Kounis syndrome. This case highlights a rare and life-threatening presentation of KS with malignant ventricular arrhythmia and underscores the importance of recognizing allergic triggers of acute coronary syndromes in emergency settings.