Spectral cardiac CT in type 1 Kounis syndrome presenting as myocardial infarction with non-obstructive coronary arteries following anaphylactic shock

Myocardial infarction with non-obstructive coronary arteries MINOCA poses a diagnostic challenge, particularly in complex clinical settings. We report the case of a 62-year-old woman who developed acute myocardial injury during severe anaphylactic shock following a Hymenoptera sting. Although she did not experience chest pain, electrocardiography revealed ST-segment elevation and cardiac biomarkers were markedly elevated. Coronary computed tomography angiography CCTA excluded obstructive coronary artery disease. Notably, delayed dual-energy spectral imaging demonstrated myocardial late iodine enhancement consistent with multifocal infarction, later confirmed by cardiac magnetic resonance imaging. In the context of anaphylaxis, these findings supported the diagnosis of type I KS. This case highlights the importance of systematic cardiac evaluation during severe allergic reactions and underscores the added diagnostic value of spectral CCTA in MINOCA presentations.