Isotretinoin
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Kounis syndrome type-I: case report A 15-year-old girl developed Kounis syndrome type-I during treatment with isotretinoin for severe acne vulgaris. The girl was diagnosed with a severe acne vulgaris and started receiving oral isotretinoin 20mg daily. Five minutes after receiving the first dose of isotretinoin, she presented to the emergency department (ED) with localised itching on the upper arms, followed by facial pruritic erythematous lesions progressed to the neck, along with chest pain and palpitations. She was admitted to the ED. Her BP was 114/58mm Hg and heart rate was 105 bpm. The girl was started on IV methylprednisolone and ranitidine along with oxygen therapy for the allergic reaction, and the pruritic erythematous lesions resolved rapidly. After 10 min, she started experiencing severe chest pain. ECG showed no abnormalities. Transthoracic echocardiography revealed mild anterior wall hypokinesia. A left ventricular ejection fraction was 52% with elevated level of troponin-I. Based on further investigations, she was diagnosed with isotretinoin-induced Kounis syndrome type-I. She was started on antihistamines and prednisolone for 4 days. After 5 days, her condition improved with normalisation of troponin-I level. She was advised to stop isotretinoin therapy. On day 5, she was discharged and was doing well on her follow-up visit after two weeks. Alatas OD, et al. Isotretinoin-induced pruritic erythematous lesions and acute chest pain in a 15-year-old girl. American Journal of Emergency Medicine 38: 1043e1-1043e3, 803499135 No. 5, May 2020. Available from: URL: http://doi.org/10.1016/j.ajem.2019.158479
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