Parasite Induced Kounis Syndrome: A Mitey Big Heart Attack"

Suttie, Isabella; Suttie, Claudia; Gereis, Joshua; Bowditch, Joseph; Suttie, Joseph J

First Reported Case of Kounis Syndrome Triggered by Hay Mites

We present the case of a 67-year-old farmer who developed acute chest pain following a severe, pruritic maculopapular rash. Despite a history of stable, non-obstructive coronary artery disease, angiography revealed no new changes, cardiac biomarkers and infection screens were unremarkable. Notably, the rash preceded typical anginal symptoms by several hours. Skin scrapings confirmed infestation with Pyemotes Tritici, a parasitic hay mite.

P. Tritici are ovoviviparous mites commonly found in stored hay, capable of explosive population growth and known to cause dermatitis (“hay itch”). They inject toxins into hosts, provoking intense inflammatory responses. Though typically benign, their venom can trigger systemic allergic reactions, including headache, vomiting, arthralgia, and in rare cases, more serious complications.

In this patient, the inflammatory mediators released in response to the mite’s toxins likely precipitated a coronary vasospasm - a phenomenon consistent with Type II Kounis Syndrome, where allergic inflammation exacerbates underlying coronary disease. To our knowledge, this is the first documented case of Kounis Syndrome induced by P. Tritici. The patient was treated with antihistamines and topical steroids, with resolution over six days. The infested hay was burnt.

While P. Tritici is being considered as a biological control agent in agriculture, this case highlights the need for caution. The potential for allergic and cardiovascular complications, particularly among at-risk individuals such as farmers, warrants further study and increased clinical awareness.