Type I kounis syndrome from paclitaxel infusion

Abstract

Coronary artery vasospasm leading to angina or myocardial infarction are among the most dangerous cardiotoxic effects of chemotherapeutic agents. The most well recognized association is with antimetabolite agents 5-fluorouracil and its prodrug capecitabine [1,2]. Paclitaxel is a microtubule-targeting drug of the Taxane family. It is widely used for the treatment of a range of cancers, namely breast, ovarian and lung. Its most commonly documented cardiac adverse effects have been bradycardia and heart block. Kounis syndrome has been described in a limited number of case reports explaining Paclitaxel and its association with acute coronary syndrome due to plaque rupture (Type 2 Kounis Syndrome) [3-5]. However, in these cases, patients have had pre-existing coronary artery disease or percutaneous coronary intervention. We report a patient treated for non-small cell lung cancer who presented with acute ST elevation shortly after a second paclitaxel infusion who was found to have no evidence of angiographic coronary artery disease. This is the first case report to our knowledge describing Type 1 Kounis Syndrome with Paclitaxel.