Kounis syndrome, also known as allergic acute coronary syndrome, represents the concurrence of acute coronary events with hypersensitivity reactions. It is an under recognized but potentially fatal condition triggered by drugs, foods, insect stings, or environmental exposures1. We report a case of suspected Kounis syndrome following intravenous ceftriaxone administration, presenting with anaphylactic shock, respiratory failure requiring mechanical ventilation, and biochemical evidence of myocardial injury. The patient recovered with supportive and anti allergic management without undergoing coronary angiography. This case highlights the importance of early recognition of Kounis syndrome in patients who develop cardiovascular collapse after exposure to potential allergens