Kounis syndrome type III, multiorgan failure due to Loxosceles bite with coronary thrombosis and intestinal perforation: a systematic review
DOI:
https://doi.org/10.70577/hmmcs262Keywords:
Kounis syndrome, loxoscelism, coronary thrombosis, multiorgan failure, intestinal perforation, anaphylaxis, mast cells, acute coronary syndromeAbstract
Introduction: Kounis syndrome (KS) is a medical emergency characterized by the development of acute coronary syndrome secondary to an allergic or anaphylactic reaction, triggered by mast cell degranulation and the release of inflammatory mediators that can induce coronary vasospasm, thrombosis, or plaque rupture (Kounis & Zavras, 1991; Kounis, 2016). Loxoscelism, caused by the bite of spiders of the genus Loxosceles, represents a rare but potentially lethal trigger of KS, which can manifest with multisystem involvement including coronary thrombosis, multiorgan failure, and gastrointestinal complications such as intestinal perforation (Kounis, 2016; Langner et al., 2021). Objective: To synthesize the available evidence on Kounis syndrome type III triggered by loxoscelism, with emphasis on complications of coronary thrombosis, multiorgan failure, and intestinal perforation. Methodology: Systematic review following PRISMA 2020 guidelines (Page et al., 2021). A systematic search was conducted in PubMed, LILACS, SciELO and Cochrane for studies published between 2000 and 2026 reporting KS associated with loxoscelism. Case reports, case series, and observational studies were included. Quality was assessed using the adapted Newcastle-Ottawa scale (Wells et al., 2000). Results: Eight studies reporting KS associated with loxoscelism were identified. Reported cases included acute cardiovascular manifestations with elevation of cardiac biomarkers and electrocardiographic changes compatible with acute coronary syndrome (Navarro-Martinez et al., 2022; Kounis, 2016). Pathophysiology involves mast cell degranulation with release of histamine, leukotrienes, platelet-activating factor, and neutral proteases, which can induce coronary vasospasm and thrombosis (Kounis, 2016). Type III KS, characterized by stent thrombosis, has been documented in patients with pre-existing coronary disease exposed to Loxosceles venom (Mohta et al., 2023). Multiorgan failure has been reported in cases of visceral loxoscelism, with renal, hepatic, hematologic, and cardiovascular involvement (Langner et al., 2021). Conclusion: Kounis syndrome type III secondary to loxoscelism represents an exceptional but potentially lethal complication that requires a high index of suspicion and urgent multidisciplinary management. Early identification of anaphylaxis signs and cardiovascular monitoring are essential to reduce associated morbidity and mortality.
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Copyright (c) 2026 Velky Virginia Villavicencio Vallejo, Karol Natalie Galarza Avila, Jorge Luis Rivadeneira Chamorro, Martha Giovanna Herrera Moreno, Yajaira Lizbeth Vargas Ledesma (Autor/a)
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