[Pubmed] South African Flag Sign in Contrast-Induced Kounis Syndrome: When the Flag Misleads

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JACC Case Rep. 2026 Jul 30:109549. doi: 10.1016/j.jaccas.2026.109549. Online ahead of print.

ABSTRACT

CASE SUMMARY: A 45-year-old woman with myasthenia gravis developed acute chest pain minutes after iodinated contrast administration. Electrocardiography showed high lateral ST-segment elevation. Emergent coronary angiography revealed no obstructive disease, with rapid resolution of ST-segment changes. Elevated troponin and regional wall motion abnormality were noted. The temporal association supported a diagnosis of type I Kounis syndrome.

TAKE-HOME MESSAGES: Contrast-induced hypersensitivity can mimic ST-segment elevation myocardial infarction, with characteristic electrocardiographic patterns. Urgent angiography remains essential when occlusive myocardial infarction cannot be excluded.

PMID:42530509 | DOI:10.1016/j.jaccas.2026.109549


Source: https://pubmed.ncbi.nlm.nih.gov/4253050 ... t5+40e1b98