1) Introduction: Kounis syndrome (KS) is an acute coronary syndrome (ACS) triggered by hypersensitivity or allergic reactions, most commonly following exposure to allergens such as insect stings, drugs, or environmental factors. This syndrome is likely underdiagnosed due to its rarity and varied clinical presentation.

2) Methods: This is a single-patient case report based on clinical encounter and follow-up in the emergency department, conducted with patient consent. Key clinical events, diagnostic findings, and therapeutic interventions are detailed to illustrate the diagnosis and management of KS secondary to bee sting.

3) Case: This is the case of a 45-year-old man with known past medical history of type 2 diabetes mellitus and hypertension. This gentleman presented to the Emergency Department 45 minutes after sustaining multiple bee stings to his neck. He reported generalized itching, chest pain, and difficulty breathing. Examination revealed urticarial wheals on the back and chest, pruritus, tachycardia (heart rate 121 bpm), tachypnea (respiratory rate 32/min), oxygen saturation of 97% on room air, and hypotension (BP 88/42 mmHg). Standard guidance was followed to treat anaphylaxis. Due to persistent chest pain, an ECG was recorded, which demonstrated an anterior wall ST-elevation myocardial infarction (STEMI). The patient was admitted under cardiology, underwent coronary angiography, and received a stent to the left anterior descending (LAD) artery. This presentation of STEMI in the context of anaphylaxis is consistent with Kounis syndrome.

4) Conclusion: This case highlights the need for clinicians to maintain a high index of suspicion for Kounis syndrome in patients presenting with ACS symptoms in the context of an allergic reaction, particularly following bee stings. Prompt recognition and coordinated management of both the allergic and cardiac components are essential for optimal outcomes. Increased awareness and reporting of such cases will aid in early diagnosis and improve patient care.