Rationale: Drug-induced disease is a common clinical entity. Drug-inducing anaphylaxis is a serious adverse effect. Several cases of allergic acute coronary syndrome or Kounis syndrome were reported. Premature ventricular contractions are the most frequent cardiac arrhythmia with or without structural heart diseases. A premature ventricular contraction is a sign of decreased oxygenation to the myocardium and anxiety but is also found in a healthy heart.
Patient concerns: A middle-aged married male patient presented to the physician's outpatient clinic with syncope within one hour after ingesting one tablet of diclofenac potassium (50mg).
Diagnosis: Diclofenac potassium-induced anaphylaxis and Kounis type I syndrome with premature ventricular contractions
Interventions: Electrocardiography, oxygenation, monitoring for vital signs, and echocardiography.
Outcomes: The dramatic disappearance of anaphylactic shock, Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions after the traditional treatment of anaphylaxis had happened. Complete clinical and electrocardiographic recovery had achieved.
Lessons: The identification of drug-induced disease is a pivotal step in the diagnosis and decision-making of any medical problems. Diclofenac potassium can induce anaphylactic shock, Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions. Kounis type I syndrome, coronary artery spasm, and premature ventricular contractions can be reversed with treatment of the cause without using anti-ischemic or ant-arrhythmic measures. Reassurance was recommended regards diclofenac potassium-induced both coronary artery spasms and premature ventricular contractions that are accompanied by anaphylaxis.
Keywords: Diclofenac potassium, Drug-induced, Anaphylaxis, allergic angina, Kounis-Zavras syndrome, Premature ventricular contractions.
Abbreviations: ACS: acute coronary syndrome; CAS: coronary artery spasm; ECG: Electrocardiogram; ICU: Intensive care unit; IHD: Ischemic heart disease; KS: Kounis-Zavras syndrome; MI: Myocardial infarction; NSR: Normal sinus rhythm; O2: Oxygen; PVCs: Premature ventricular contractions; SCD: Sudden cardiac death; SHD: structural heart diseases; VR: Ventricular rate