Kounis syndrome (KS) should be recognized as a potential cause of acute coronary events, particularly in individuals without prior coronary artery disease (CAD). This report highlights a case of KS triggered by an insect bite,emphasizing the importance of considering KS as a cause of ACS.

Case Presentation: A 55-year-old male with  H/O Diabetes presented to the ER with an allergic reaction to an ant bite. The patient had history of allergic reactions to insect bites but had never experienced cardiovascular symptoms. During examination, he was clinically stable. Cardiovascular examination was normal, his chest was clear. He was treated with injectable antihistamines and steroids., Patient experienced central chest pain and vomiting after sometime. An  ECG showed ST depression in leads V4 to V6 and mild ST elevation in lead aVR. The patient was referred to cardiology for further evaluation. Cardiac enzyme was elevated (HS Trop T - 294.9 pg/ml), echocardiography showed hypokinesia in the basal inferolateral segments. The patient was diagnosed as Acute Coronary Syndrome (ACS), Non-ST-Elevation Myocardial Infarction (NSTEMI). Standard ACS management was initiated, including Inj.LMWH, antiplatelets, statins,beta-blockers, ACEI and other supportive measures. The patient was scheduled for a coronary angiogram.CAG revealed normal coronary arteries, suggesting that the cardiac event was due to vasospasm. Kounis syndrome, first identified by Kounis and Zavras in 1991 as "allergic angina," involves the simultaneous occurrence of acute coronary syndrome triggered by hypersensitivity reactions. It occurs when mast cell activation due to allergic or hypersensitivity reactions releases inflammatory cytokines, leading to coronary artery vasospasm or plaque rupture. This syndrome can be triggered by various environmental factors and drugs. This case underscores the significance of considering Kounis syndrome in patients presenting with acute coronary events, especially those without a history of CAD but with recent exposure to potential allergens, such as insect bites.