Kounis syndrome after patent blue dye injection for sentinel lymph node biopsy
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CASE REPORT
Kounis syndrome after patent blue dye injection for sentinel lymph node biopsy Maximos Frountzas1 · Panagiotis Karathanasis1 · Gavriella Zoi Vrakopoulou1 · Charalampos Theodoropoulos1 · Constantinos G. Zografos2 · Dimitrios Schizas2 · George C. Zografos1 · Nikolaos V. Michalopoulos1,3 Received: 11 May 2020 / Accepted: 22 June 2020 © The Japanese Breast Cancer Society 2020
Abstract Background Kounis syndrome (KS) has been described as an acute coronary syndrome (ACS) associated with an anaphylactic reaction. Several triggers have been identified and the diagnostic and treatment process can be challenging. Case A 58-year-old, female patient diagnosed with breast cancer and no history of allergies had subcutaneous injection of patent blue V dye for sentinel lymph node biopsy (SLNB). Intraoperatively, she developed anaphylactic shock and was transferred to the intensive care unit (ICU). A few hours later, electrocardiographic alterations and elevation of blood troponin were observed. Emergency coronary angiography revealed no occlusive lesions in coronary vessels. Further investigation in the allergy department set the diagnosis of KS. Conclusion There are just ten cases of perioperative KS in the literature so far and here we present the first one triggered by patent blue V dye for sentinel node biopsy. Keywords Kounis syndrome · Patent blue · Sentinel node biopsy
Introduction Sentinel lymph node biopsy (SLNB) has been considered as the gold standard method for axillary staging in early breast cancer. Surgeons traditionally utilize intra-parenchymal injection of blue dye, either alone or in combination with a radiotracer [1]. Patent blue violet (V) has been the most commonly used blue dye outside the USA, despite its minor allergic reaction risk, which is below 1% [2]. Patent blue V allergic reactions could vary from simple cutaneous manifestations to cardiac arrest [3].
* Maximos Frountzas [email protected] 1
1st Department of Propaedeutic Surgery, Medical School, “Hippocratio” General Hospital, University of Athens, 114 Vas. Sophias Av, 11527 Athens, Greece
2
1st Department of Surgery, Medical School, University of Athens, “Laiko” General Hospital, 17 Agiou Thoma St, 11527 Athens, Greece
3
4th Dept. of Surgery, Medical School, “Attikon” University Hospital, University of Athens, 1 Rimini St, 12462 Chaidari, Greece
Kounis Syndrome (KS) is an extremely rare anaphylactic reaction to various allergens, which is associated with acute coronary syndrome [4]. KS leads to hypovolemic shock of cardiogenic etiology, that actually should be treated as an anaphylactic one. Herein we present the first case in the literature concerning KS after patent blue V injection for SLNB in early-stage breast cancer.
Case report A 58-year-old Caucasian woman with an invasive ductal carcinoma in the upper outer quadrant of the right breast was scheduled for breast conserving operation and axillary sentinel lymph node biopsy. Her past medical history included only a mild dilatation of the thoracic aorta
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