Allergic Angina with QTc Prolongation and Wellens Type-A Syndrome Post-ceftriaxone Parallel to COVID-pneumonia-A New Causation and Treatment

Abstract

Rationale: Antibiotics may cause serious adverse effects. Allergic acute coronary syndrome (ACS) or Kounis Zafras (KZ) syndrome is a newly described syndrome relevant to allergen exposure. Coronavirus disease 2019 (COVID-19) infection may have lethal cardiovascular and respiratory complications. Wellens syndrome is particular for critical stenosis of the left anterior descending artery. However, there is a strong relationship between coronary artery disease and COVID-19 infection. Patient Concerns: A 28-year-old married homemaker Egyptian female patient was admitted to the intensive care unit with angina, QTc prolongation, and Wellens type-A syndrome after ceftriaxone injection post-COVID-pneumonia. Diagnosis: Allergic angina with QTc prolongation and Wellens type-A syndrome post-ceftriaxone Parallel to COVID-pneumonia. Interventions: Oxygenation, arterial blood gas, electrocardiography, and echocardiography. Outcomes: Gradual dramatic clinical, and electrocardiographic improvement had occurred. Lessons: Ceftriaxone-inducing allergic ACS or KZ syndrome with QTc prolongation and Wellens type-A syndrome post-COVID-pneumonia is a distinctive new adverse effect. The widespread non-ST-segment elevation myocardial infarction with ST-segment elevation in aVR lead and T-wave inversion in anterolateral leads or Wellens syndrome type A may be interpreted as accompanied by multi-vessels disease. An associated COVID-19 infection may be an exacerbated factor for the ceftriaxone-inducing allergic ACS.