Table 1. Overview of vancomycin-induced Kounis Syndrome cases reports from the literature.

Authors [Reference #]	Age and Sex	Presenting Complaint, Primary Diagnosis	Past Medical History	Drug Exposure	Post-Exposure Presentation	Serum Troponin-I	ECG Findings	KS Treatments
Present Study	41, M	Rash, cellulitis	Hidradenitis suppurativa, psoriasis, tobacco use	IV Vancomycin (2 g)	Chest discomfort, nausea, diaphoretic, headache	199 ng/L	T-wave inversions in inferior lateral leads, IVCD	Sublingual nitroglycerin (0.4 mg), oral aspirin (325 mg and 81 mg), IV heparin (11.3 units/kg/hr)
Martinez et al.6	83, F	Knee pain, infected joint	Hypothyroidism, HTN, AVR, HLD, BTKA	IV Vancomycin (15 mg/kg)	Unresponsive, agonal respiration, thready pulse	Undetectable (<0.017 ng/mL)	ST elevation in inferior-lateral leads, reciprocal ST changes in precordial leads	IV diphenhydramine (50 mg)
Leibee et al.12	57, M	Toe pain, osteomyelitis	PAD, DM, HTN, tobacco use	IV Vancomycin (15 mg/kg)	Diaphoretic, headache, chest pain	Undetectable (<0.04 ng/mL)	ST-segment elevation and hyperacute T waves in the inferior leads, reciprocal ST segment depression in high lateral leads	IV normal saline (1L), IV diphenhydramine (50mg q20 min), oral aspirin (325 mg q20 min),a
Gagnon et al.10	32, M	Inguinal abscess, cellulitis	Migraines, ADHD, toba ohh cco use	IV ceftriaxone; Oral TMP-SMX and metronidazole; IV Vancomycin (2 g loading dose,1.5 g q8h)	Chest pressure, nausea, right-arm paresthesia	12,230 ng/L	ST-segment elevation in the inferior leadhout reciprocal changes	Nitroglyceri, amlodipine (5 mg)a

Notes.

IVCD

Intraventricular conduction delay

HTN

hypertension

AVR

Aortic valve replacement

HLD

hyperlipidemia

BTKA

Bilateral total knee arthroplasty

PAD

Peripheral artery disease

DM

diabetes mellitus

ADHD

Attention deficit hyperactive disorder

TMP-SMX

Trimethoprim-sulfamethoxazole

q8H

every 8 hours

^aVancomycin infusion stopped.