Clinical Ischemic Heart Scombroid Syndrome: A Presumed Case of Kounis Syndrome
Piccolo A, Strati P, Taglieri A, Romano C, Bava A, Adornato E, Macheda S, Tescione M
Scombroid poisoning is a type of food poisoning that results from the consumption of fish with high levels
of histamine due to improper storage. The implementation of proper food handling and storage practices
in the fishing industry, distribution, and retail sectors plays a crucial role in preventing scombroid
poisoning. It is generally not considered life-threatening, but its symptoms can be uncomfortable and,
in some cases, severe. Ischemic heart Scombroid Syndrome is a rare, usually transient, complication
of scombroid poisoning, caused by coronary vasospasm in response to a nitroxide-mediated histamineinduced tissue hypoperfusion. We present the case of a 21 – years old female with no history of coronary
artery disease (CAD) or atopy, who entered the Emergency Department after eating cooked tuna. She
was immediately treated with intravenous antihistamine and cortisone. However, she suffered chest
pain and severe hypotension, needing admission in the Intensive Care Unit and blood pressure support
with vasopressors. Patient’s final diagnosis was vasospastic angina due to presumed scombroid fish
poisoning (SFP), a rare form of acute myocardial damage with nonobstructive coronary arteries
secondary to coronary vasospasm, also known as “Ischemic heart Scombroid Syndrome” (ISS), causing
a Kounis Syndrome type 1. Prompt recognition and management of both the allergic reaction and
cardiovascular symptoms are crucial in the treatment of Ischemic heart Scombroid Syndrome.
