Acute Kounis Syndrome Induced by Tramadol: A Case Report.

Kounis syndrome is an under-recognized condition characterized by the simultaneous occurrence of acute coronary syndrome and hypersensitivity reactions. While opioids are known triggers, tramadol-induced Kounis syndrome is extremely rare. A 49-year-old woman with a history of allergy to dimenhydrinate and chronic low back pain developed anaphylactic shock 4 min after receiving 50 mg of subcutaneous tramadol. She developed with dyspnea, glottic edema, muscle rigidity, chest pain, and hypotension. After stabilization with epinephrine, corticosteroids, antihistamines, fluids, and vasopressors, elevated cardiac biomarkers were detected. Electrocardiograms and echocardiography were normal. Coronary CT and invasive angiography revealed no obstructive coronary artery disease. A diagnosis of Kounis syndrome was established. This case highlights the importance of considering Kounis syndrome in patients presenting with anaphylaxis and chest pain, even in the absence of ECG changes. Early hemodynamic stabilization followed by cardiac evaluation is essential for timely diagnosis and management.