A case of Kounis syndrome aggravated by administration of morphine.

Abstract

known. The presence both of these diseases in this patient bring to our mind the role of the inflammation or the presence of shared genetic predisposition. The role of infection or inflammation in the etiology of ARVD was proposed and thought is the remnant of myocarditis. Fontaine et al. (1) in examining 27 patients, they found inflammatory infiltrations in eight of them. In other site of view, the major genetic risk factor for RA is class II histocompatible complex alel HLA-DR4. Meanwhile ARVD shows different type of family genetic transmission in which the plakophilin (PKP2) mutation has been found as a major cause of ARVC/D with prevalence of mutations among unrelated index cases as high as 43% (3, 4). It is unexplained whether unknown genetic mutation or the effect of inflammation played a main role in the etiology of our case. However, it is logical to keep in our mind the diagnosis of ARVD in-patient with rheumatoid arthritis when presented to us with malignant ventricular arrhythmias. In these conditions clinical evaluation with meticulous echocardiography examination, cardiac MRI and right ventriculography should be done and if it is possible to be supported by genetic study.