Bee sting-induced myocardial infarction: a systematic review with illustrative case

Objective: To systematically review and analyze published case reports and case series describing myocardial infarction following bee stings, with a focus on identifying patterns in clinical presentation, diagnostic findings, and management strategies associated with Kounis Syndrome. Methods: This manuscript has a dual structure: a systematic review of published case reports and a concise representative case from our institution. The review was conducted according to PRISMA guidelines (PROSPERO registration CRD420251105654). PubMed, Scopus, and Web of Science databases were searched up to July 10, 2025, for English-language case reports and series documenting MI following bee stings. Eligible studies included clinically confirmed cases of MI temporally related to bee envenomation. Data extraction included demographics, clinical features, diagnostics, treatments, and outcomes. Descriptive analysis was performed. We also present a representative case to illustrate typical clinical presentation and management. Results: Seventeen cases of bee sting-associated MI were included. The mean patient age was 55.1 years, and 82.4% were male. Most cases (70.6%) were classified as Type II Kounis Syndrome. Chest pain was the most common symptom (94.1%), and anaphylaxis occurred in 52.9% of patients. ST-elevation MI was reported in 82.4% of cases, with the inferior and anterior leads most commonly affected. Coronary angiography revealed pathological findings in 76.5% of patients, and percutaneous coronary intervention was performed in 70.6%. Despite complications such as shock (41.2%) and arrhythmias (17.6%), 94.1% of patients experienced full recovery. Conclusion: Bee sting-induced myocardial infarction is a rare but potentially life-threatening manifestation of Kounis Syndrome, most often involving ST-elevation and allergic features such as anaphylaxis. Management typically includes dual antiplatelet therapy, PCI, and anti-allergic treatment. © The Author(s) 2025.