DOI: 10.36347/sjmcr.2015.v03i09.012

Pages: 834-837

A 78-year-old male felt abdominal discomfort and nausea after eating lunch with 350 ml of beer. He went to the toilet due to diarrhea and subsequently felt faintness and called his family with a handy-phone. When his family assessed him, he was found to be in an unconsciousness state. Upon arrival, he demonstrated disorientation with words, with a blood pressure of 76/42 mmHg, heart rate of 82 BPM, and displayed both erythroderma and dysarthria. A chest roentgenogram and electrocardiogram were all negative. He received a rapid infusion of 500 ml of lactate ringer, and his blood pressure showed a transient increase; however, reducing the speed of the infusion resulted in repeat hypotension. A repeat electrocardiogram indicated elevation of ST at the aVR lead. An urgent coronary angiogram showed mild diffuse spastic changes in both right and left coronary arteries, which resolved with the infusion of Nicorandil. As he remained in a hypotensive state with erythroderma, an anaphylactic reaction was suspected. Administration of Chlorpheniramine had a dramatic effect, and the patient demonstrated normo tension with a normal color skin. The troponin T level increased to 0.337 (0.032 >) ng/ml on the second hospital day. Finally, he received a diagnosis of coronary vasospasms secondary to food allergies. Special attention should be paid to anaphylactic complaints and the findings of real-time electrocardiograms, as well as the levels of cardiac markers, in order to ensure a correct diagnosis and a good outcome of treatment.