Coronary vasospasm induced by cytostatic drugs: Kounis syndrome seems to be the most likely culprit.

I n a very important paper published recently in the Hellenic Journal of Cardiology,1 the authors described a 52-year-old female patient with no history and no predisposing factors for coronary artery disease, who developed chest pain with electrocardiographic changes suggesting coronary artery spasm following capecitabine administration for colorectal cancer. The authors of this report attributed this reaction to capecitabine cardiotoxicity, endothelial activation, thrombogenic effects and autoimmune phenomena. However, it seems likely that this patient had suffered capecitabine-induced hypersensitivity reaction, culminating in hypersensitivity-associated acute coronary syndrome, the so called Kounis syndrome.2