Time to Reconsidering the Potential Role of Leech Salivary Proteins in Medicine: Type-II Kounis Syndrome Triggered by Leech Bite
Tas S, Yildiz BS, Ersin A, Tas U (2025) · Pakistan Journal of Medical Sciences · n=1
Studienprofil
- Design
- single case report of a 58-year-old male presenting with allergic myocardial infarction (Type-II Kounis syndrome) following a leech bite, with subsequent coronary angiography demonstrating 90% stenosis of the circumflex artery and successful stent placement (Department of Cardiology, Manisa Celal Bayar University, and Department of Cardiology, Izmir Demokrasi University, Turkey)
- Stichprobengröße (n)
- 1
- Intervention
- Description of acute Type-II Kounis syndrome (allergic myocardial infarction) presentation following a leech bite in a patient without prior allergic history; emergency management included cardiopulmonary resuscitation for 10 minutes, intravenous antihistamine, prednisolone, and adrenaline; intensive care monitoring; coronary angiography with stent implantation
- Komparator
- Not applicable - single-patient case report
- Primärer Endpunkt
- Documentation of Kounis syndrome as a serious adverse event of leech bite exposure; identification of leech salivary proteins as a potential trigger of acute coronary syndrome via type I-II hypersensitivity mechanisms
- Primäres Ergebnis
- Successful resuscitation and revascularization with circumflex coronary artery stenting; patient stabilized; case demonstrates that leech bite can trigger Kounis syndrome with simultaneous anaphylaxis and acute coronary syndrome even in patients without prior allergy history; report calls for increased clinical awareness of this rare but potentially lethal complication
- Follow-up-Dauer
- duration of inpatient stay plus post-discharge cardiology follow-up
- PMID
- 39867760
Wichtigste Ergebnisse
- First reported case in the cardiology literature of Type-II Kounis syndrome triggered by leech bite
- Demonstrates simultaneous allergic and ischemic pathways from leech salivary protein exposure
- Patient required 10 minutes of CPR and emergency cardiology intervention with stent placement
- Strongly reinforces the ASH not-for-home-use guidance and need for clinician supervision
- Calls for clinical awareness of Kounis syndrome in the differential for chest pain after leech exposure
Einschränkungen
- Single case (n=1) - cannot establish incidence or risk factors
- Pre-existing coronary artery disease in the patient is a confounder
- Causation of acute coronary syndrome by leech allergic reaction inferred but not proven mechanistically
- No molecular allergen characterization reported
- Setting (environmental leech exposure, not medical therapy) — relevance to K040187 medical therapy is contextual
Klinische Implikationen
Tas 2025 documents the first cardiology-literature case of Type-II Kounis syndrome triggered by leech bite, demonstrating that leech salivary proteins can simultaneously trigger anaphylaxis and acute coronary syndrome. For US clinicians administering K040187-cleared medical leech therapy, the trial reinforces the necessity of pre-therapy allergy screening, cardiac risk assessment in elderly or coronary-disease patients, and readiness to manage anaphylaxis with concurrent acute coronary syndrome. The trial complements Wanandy 2024 (leech anaphylaxis with Hymenoptera cross-reactivity) and the broader allergy literature in framing the rare but serious cardiovascular allergic complications of leech exposure.
Verwandte Studien
Leech Me Alone! Atraumatic Hemarthrosis after Hirudotherapy
Curcio J, Lloyd CM (2020)
Leech-bite induced anaphylaxis with or without Hymenoptera venom sensitization
Wanandy T, Bradley I, Tovar Lopez CD, Cotton BTB, Handley SA, Mulcahy EM, Adriana Le TT, Lau WY (2024)
Unusual, Uncommon, Intriguing, and Significant Causes of Kounis Syndrome: Important Medications and Chemicals Used to Treat Kounis Syndrome and Myocardial Infarction Can Cause Kounis Syndrome
Kounis NG, de Gregorio C, Hung MY, Giamouzis G, Michalaki MA, Özkan U, Ceasovschih A, Mplani V, Dousdampanis P, Kouni SN, Stefanidis A, Nastouli KM, Bozika M, Patsouras N, Koniari I (2025)
Non-Occlusive Mesenteric Ischemia Due to Hirudotherapy: A Case Report
Akalın Ç, Ekmen N (2020)