A challenge in emergency department: a case report of oxaliplatin-induced Kounis syndrome

Background: Oxaliplatin is a platinum derivative commonly used in patients with advanced colorectal cancer. Hypersensitivity reactions to platinum-derived drugs represent a rare acute toxicity. It has been previously described a particular form of drug hypersensitivity that selectively affects the cardiac tissue, called allergic angina or Kounis syndrome. The mast cell degranulation is the main pathophysiological cause of this syndrome, and is mainly triggered by antibiotics and hymenoptera venom in sensitized individuals. Here we further identified oxalin-specific B cells that proliferate in response to oxaliplatin stimulation. Case Description: We describe herein a case of a 52-year-old woman admitted to the Emergency room due to chest pain upon oxaliplatin administration (4th cycle). By mean of electrocardiography, troponin level evaluation, transthoracic echocardiography and coronary angiography, we diagnosed the patient with Kounis syndrome. Moreover, using a flow cytometry-based proliferation assay in vitro, we confirmed the presence of oxaliplatin-specific proliferating B cells. The patient was hospitalized in coronary care unit (CCU), and experienced remission of cardiac symptoms. Conclusions: In an Emergency Medicine setting, the right diagnosis and the adequate treatment of this syndrome still represent a challenge to avoid post-allergic myocardial effects including ischemia, conduction defects, arrhythmias, and dysfunction of the cardiac muscle cells.