CASE SUMMARY: A 52-year-old man developed an inferior ST-segment elevation myocardial infarction following a bee swarm attack. Standard thrombolysis with streptokinase triggered severe hemodynamic collapse and systemic hemorrhage. Upon recognizing KS, management was shifted to steroids and antihistamines, leading to complete recovery. Recurrence was documented 8 years later following an ant bite.
DISCUSSION: This case illustrates how standard acute coronary syndromes treatments, such as antigenic thrombolytics, can inadvertently exacerbate the allergic cascade in KS. It highlights the need to maintain a high index of suspicion when cardiac symptoms follow an allergic trigger.
TAKE-HOME MESSAGES: Avoid antigenic thrombolytics when KS is suspected to prevent iatrogenic clinical deterioration. Primary percutaneous coronary intervention and early allergy management are the preferred clinical strategies.
CASE SUMMARY: A 59-year-old man presented with non-ST-segment elevation myocardial infarction complicated by cardiogenic shock. Despite successful percutaneous coronary intervention to critical left anterior descending and right coronary artery lesions, he remained in refractory shock requiring escalating inotropic support. Retrospective recognition of secondary hypothyroidism and a bitemporal visual field defect raised suspicion of pituitary insufficiency. Empiric hydrocortisone resulted in rapid hemodynamic recovery. Subsequent evaluation confirmed panhypopituitarism, whereas magnetic resonance imaging demonstrated a cystic sellar lesion compressing the pituitary gland.
DISCUSSION: Secondary adrenal insufficiency should be considered when shock persists despite successful revascularization and cardiac recovery.
TAKE-HOME MESSAGE: Early glucocorticoid replacement may be lifesaving and should not await hormonal confirmation when adrenal crisis is suspected.