D3.349 - Takotsubo cardiomyopathy triggered by anaphylaxis after a honey bee sting, forming ATAK complex: a rare case report

Background: Takotsubo cardiomyopathy is an acute and reversible left ventricular dysfunction that mimics acute coronary syndrome. In rare cases it occurs in the context of anaphylaxis, forming the ATAK complex (Anaphylaxis, Takotsubo and Kounis syndrome).

Case summary: A 25-year-old male presented with anaphylaxis following a honey bee sting, treated with intramuscular adrenaline. During the acute phase, the patient experienced chest pain, and ECG changes suggestive of myocardial infarction while troponin elevated. Echocardiography demonstrated apical ballooning consistent with Takotsubo cardiomyopathy while coronary angiography demonstrated unobstructed coronary arteries. During hospitalization in the cardiac intensive care unit, supportive management led to complete recovery of left ventricular systolic function (EF 55%) within days.

Discussion: This case illustrates the clinical and pathophysiological overlap described as the ATAK complex. It suggests a shared immune-neurohormonal pathway mediated by mast cell activation, inflammatory mediators and catecholamine surge during anaphylaxis, all of which may contribute to transient left ventricular dysfunction. It also emphasizes the therapeutically paradox of adrenaline as potential contributor to myocardial dysfunction.

Conclusion: Hymenoptera venom anaphylaxis can rarely trigger Takotsubo cardiomyopathy, fitting into the ATAK complex framework. Awareness of this overlap is essential for timely diagnosis and emphasizes the need of early echocardiography in anaphylaxis and chest pain.