• Fahad Rajh, Rawia Raja, Fares Rajah, and Abdulaziz AlAli.
• Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
• J Emerg Med. 2019 Jul 1; 57 (1): e5-e8.

BackgroundKounis syndrome (allergic myocardial infarction) is the rare occurrence of systemic anaphylaxis with spontaneous electrocardiographic changes in response to an exogenous agent. Often the syndrome is caused by a drug reaction involving drugs such as non-steroidal anti-inflammatory drugs, antibiotics, or opioids. There are a few reported cases in the literature regarding diclofenac-induced Kounis syndrome, and little is known about the management of this clinical entity.Case ReportA case of Kounis syndrome with ST-elevation myocardial infarction secondary to intramuscular (i.m.) diclofenac in a patient with prior coronary artery bypass graft surgery is described in this report. Additionally, we discuss the pathophysiology, clinical presentation, and management of this rare clinical entity. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As i.m. diclofenac is a commonly used drug in the emergency department, we urge emergency physicians to be aware of the existence of this potentially fatal diclofenac-related adverse drug effect. If Kounis syndrome is suspected, the emergency physician is advised to balance the benefit of epinephrine for the treatment of anaphylaxis with the small theoretical risk of increasing coronary vasospasm.Copyright © 2019 Elsevier Inc. All rights reserved.

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