Bee Venom-Induced Immunologic Myocardial Infarction: A Rare Case of Kounis Syndrome.

BACKGROUND: Kounis syndrome is a rare cause of acute coronary syndrome (ACS) triggered by hypersensitivity reactions. Bee venom is a recognized precipitant because of its potent allergenic proteins. CASE SUMMARY: A 50-year-old woman developed urticaria, angioedema, and severe chest pain minutes after a bee sting. Troponins rose exponentially, electrocardiogram demonstrated nonspecific ST segment changes, echocardiography revealed anterior wall hypokinesis, and angiography demonstrated nonobstructive coronary arteries. She was treated with anaphylaxis-directed therapy and vasospasm management, with full recovery. DISCUSSION: This case highlights the diagnostic and therapeutic challenges of Kounis syndrome, a frequently underrecognized cause of ACS. Current American College of Cardiology/American Heart Association and European Society of Cardiology guidelines do not provide disease-specific recommendations, requiring clinicians to balance anaphylaxis treatment with established ACS therapies. Early recognition is essential to avoid misdiagnosis and guide appropriate management. TAKE-HOME MESSAGES: Suspect Kounis syndrome when chest pain coincides with allergic reactions. Early recognition enables appropriate treatment and helps prevent misdiagnosis.