amoxicillin-potassium-clavulanate-combination and Angina-Pectoris

The authors report a case of Lemierre's syndrome. This uncommon clinical entity is characterized by a septic internal jugular vein thrombosis with secondary metastatic abscesses and Fusobacterium necrophorum septicemia, following an acute oropharyngeal infection. The diagnosis is primarily clinical and it should be suspected when a severe septicaemic illness, with pulmonary symptoms, occurs after an acute pharyngotonsillar infection. This article reviews the clinical picture, microbiology and treatment of this forgotten complication of acute tonsillitis.

Topics: Abscess; Acute Disease; Aged; Amoxicillin-Potassium Clavulanate Combination; Angina Pectoris; Anti-Bacterial Agents; Anticoagulants; Clindamycin; Drug Therapy, Combination; Female; Fusobacterium Infections; Fusobacterium necrophorum; Heparin; Humans; Jugular Veins; Metronidazole; Pharyngitis; Sepsis; Syndrome; Thrombosis; Tonsillitis; Ultrasonography, Doppler

The concurrence of acute coronary syndrome with allergy or hypersensitivity as well as with anaphylactic or anaphylactoid reactions is increasingly encountered in daily clinical practice. There are several reports associating mast cell activation with acute cardiovascular events in adults. This was first described by Kounis as 'allergic angina syndrome',progressing to 'allergic myocardial infarction'. The main mechanism proposed is the vasospasm of coronary arteries. We present a case of a 28-year-old man who was admitted to our hospital with thoracic pain and dyspnoea. The symptoms recurred after simultaneous use of 1 g amoxicillin/clavulanic acid orally and 1 g ampicillin/sulbactam parenterally for tonsillitis the night before presentation and on the morning of admission.

Topics: Acute Coronary Syndrome; Administration, Oral; Adult; Amoxicillin-Potassium Clavulanate Combination; Ampicillin; Angina Pectoris; Anti-Bacterial Agents; Coronary Angiography; Coronary Vasospasm; Drug Hypersensitivity; Electrocardiography; Humans; Injections, Intramuscular; Intradermal Tests; Male; Sulbactam; Tonsillitis

Myocardial injury and acute coronary syndrome have been rarely associated with amoxicillin/clavulanic acid intake. The responsible pathogenetic mechanism is described by an amplified mast cell degranulation inducing coronary artery spasm and/or acute myocardial infarction in susceptible individuals which is called Kounis syndrome. We report here a case of Kounis syndrome presented with acute coronary syndrome due to amoxicillin/clavulanic acid use. All other etiologies, including ischemic reinfarction were appropriately ruled out.

Topics: Acute Coronary Syndrome; Amoxicillin-Potassium Clavulanate Combination; Angina Pectoris; Coronary Angiography; Electrocardiography; Humans; Male; Middle Aged; Syndrome