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Case Reports in Cardiology
Volume 2015 (2015), Article ID 768089, 3 pages
http://dx.doi.org/10.1155/2015/768089
Case Report

Reversible Myocarditis and Pericarditis after Black Widow Spider Bite or Kounis Syndrome?

1Department of Cardiology, Samsun Training and Research Hospital, Ministry of Health, 55100 Samsun, Turkey
2Department of Endocrinology and Metabolism, Samsun Training and Research Hospital, Ministry of Health, 55100 Samsun, Turkey
3Department of Nephrology, Samsun Training and Research Hospital, Ministry of Health, 55100 Samsun, Turkey
4Department of Pediatrics, Ondokuz Mayıs University Faculty of Medicine, 55100 Samsun, Turkey
5Department of Cardiology, Faculty of Medicine, Cumhuriyet University, 58140 Sivas, Turkey

Received 26 April 2015; Revised 5 August 2015; Accepted 31 August 2015

Academic Editor: Filippo M. Sarullo

Copyright © 2015 Mehmet Yaman et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Clinical manifestation of black widow spider bite is variable and occasionally leads to death in rural areas. Cases of myocarditis and pericarditis after black widow spider bite are rare and the associated prognostic significance is unknown. Kounis syndrome has been defined as an acute coronary syndrome in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults that manifests as vasospastic angina or acute myocardial infarction or stent thrombosis. Allergic myocarditis is caused by myocardial inflammation triggered by infectious pathogens, toxic, ischemic, or mechanical injuries, such as drug-related inflammation and other immune reactions. A 15-year-old child was admitted to the emergency department with pulmonary edema after spider bite. ST segment depression on ECG, elevated cardiac enzymes and global left ventricular hypokinesia (with ejection fraction of 22%), and local pericardial effusion findings confirmed the diagnosis of myopericarditis. After heart failure and pulmonary edema oriented medical therapy, clinical status improved. Patient showed a progressive improvement and LV functions returned to normal on the sixth day. Myopericarditis complicating spider bite is rare and sometimes fatal. The mechanism is not clearly known. Alpha-latrotoxin of the black widow spider is mostly convicted in these cases. But allergy or hypersensitivity may play a role in myocardial damage.