LAUSR

Anaphylaxis is a severe systemic hypersensitivity response requiring urgent medical attention, with respi-ratory, cardiovascular, cutaneous or gastrointestinal manifestations associated with exposure to a trigger. The clinical presentation of acute coronary syndrome (ACS) due to coronary vasospasm in the background of allergic or anaphylactic reactions was first described in 1991 and such a phenomenon has often been termed as allergic angina or Kounis syndrome. 1 Over 90% of the cases of Kounis syndrome reported so far have been associated with serious manifestations, and of these 37% followed the intravenous administration of medications, particularly antibiotics. 2 With specific ref-erence to anaesthesia, previous presentations have been described in the context of administration of midazolam, morphine and muscle relaxants, including rocuronium and cisatracurium. 3–6 Most presentations have been described in males, between 40 and 80 years of age, and occurring within an hour of exposure to the trigger. 7 We present a case of anaphylaxis that mani-fested intraoperatively with concurrent features of coronary vasospasm following the administration of rocuronium. The patient has provided consent for pub-lication of the case report and images, and hospital ethics approval was obtained (Human research ethics committee Ref ID: 77433). This report complies with the applicable Enhancing the QUAlity and Transparency Of health Research (EQUATOR) pub-lishing guidelines. 8 A