Febrile Illness Unmasks Brugada Syndrome

Case Report

Austin J Clin Case Rep. 2014;1(4): 1016.

Febrile Illness Unmasks Brugada Syndrome

Aanchal Gupta* and Stephan L Kamholz

Department of Medicine, Albert Einstein College of Medicine, USA

*Corresponding author: Aanchal Gupta, Department of Medicine, Albert Einstein College of Medicine, 1576 Tomlinson Avenue, Bronx, , New York, 10461, USA

Received: May 21, 2014; Accepted: June 16, 2014; Published: June 18, 2014


The Brugada syndrome is characterized by right bundle-branch block pattern on Electrocardiogram (ECG), right precordial ST-segment elevation [usually leads V1/V2] and syncope/sudden cardiac death in absence of significant electrolyte abnormalities, ischemia or structural heart disease [1]. A 59 year old presented with dizziness and fever due to pyogenic liver abscess. Multiple ECG’s during the hospital admission revealed a Brugada type 1 pattern. The ECG reverted to normal when fever resolved. Mutations in the cardiac sodium-channel gene SCN5A which cause a decrease in the inward depolarizing sodium current have been associated with the Brugada syndrome [2-4]. The dysfunction of the sodium channel is exaggerated at higher than physiologic temperatures; the syndrome may be unmasked by fever increasing the risk of ventricular arrhythmias and/or sudden cardiac death [5-8]. The association of febrile illness with the potential for life-threatening cardiac events, heralded by unique electrocardiographic abnormalities, should be recognized.

Keywords: Brugada syndrome; Fever; Ventricular fibrillation

Clinical Presentation

A 59 year-old man presented complaining of right-sided neck pain, fever and chills of one day’s duration. The patient also reported pain along the right shoulder blade and ipsilateral pleuritic chest pain, headache, and dizziness without any loss of consciousness. There was no past history of syncope/loss of consciousness or of nocturnal agonal respiration. His family history was unremarkable for syncope or sudden cardiac death. He had emigrated to the U.S from China many years ago.

In the Emergency Department, fever was noted (40.2°C), with tachycardia (108 beats/min) and bibasilar rales on lung examination. The chest radiograph revealed mild decrease in bibasilar aeration with some elevation of the right hemi-diaphragm. There was no radiologic evidence of consolidation, pleural effusion or pneumothorax. ECG showed coved-type ST elevation in leads V1, V2 with right bundle branch block (RBBB) - Brugada type 1 pattern (Figure 1a). Laboratory findings were significant for leukocytosis (23,300/μL with 14% band forms), mild elevation of liver function tests (Table 1) and normal troponin. Transthoracic echocardiogram revealed a normal left ventricular ejection fraction and with no regional wall motion abnormality.