Bee Sting-Associated Kounis Syndrome Presenting as Myocardial Infarction: A Case Report and Systematic Review with Age-Based Analysis.

Authors

Ahmet Yetkin, Ömer Faruk Yılmaz, Mehmet Semih Belpınar, Anastasia Balta, Yusuf Ziya Şener

Published in

Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir. Oct 13, 2026. Epub Oct 13, 2026.

Abstract

Kounis syndrome (KS) is an uncommon acute coronary syndrome triggered by allergic or hypersensitivity reactions. Bee stings are a recognized precipitant, although the available evidence is largely limited to case reports and small case series. We present a 44-year-old man with probable bee sting-associated KS and systematically review published cases, including an exploratory age-based comparison using ≤45 years as the cutoff for myocardial infarction in younger individuals. PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scopus were searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 recommendations. A total of 47 patients were included, comprising 46 previously reported cases and our index case. The mean age was 55.7+-13.0 years, and 39/47 patients (83.0%) were male. Symptoms developed within 30 minutes in 29/47 patients (61.7%), and chest pain occurred in 41/47 (87.2%). Type II KS predominated (29/43, 67.4%), while ST-segment elevation myocardial infarction (STEMI) occurred in 37/47 patients (78.7%), and revascularization was performed in 27/47 (57.4%). Cardiogenic shock, cardiac arrest, and rhythm or conduction disturbances occurred in 11/46 (23.9%), 5/46 (10.9%), and 7/46 patients (15.2%), respectively. Recovery at the last reported assessment was documented in 45/46 patients (97.8%), with no reported deaths. No follow-up data were available after the index patient left the hospital against medical advice approximately five hours after presentation. Thirteen patients (27.7%) were aged ≤45 years; age-stratified descriptive analyses did not reveal clear differences in most clinical characteristics; however, interpretation was limited by the small number of younger patients. Bee sting-associated KS may cause severe acute coronary presentations, including in younger individuals. Given the case-based and heterogeneous nature of the evidence, these findings should be interpreted cautiously and confirmed in systematically collected cohorts.

PMID:
42873993
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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