Malignant Dysrhythmias - Brugada Type 1 Pattern Formation in the Presence of Fever

Brugada is a malignant cardiac dysrhythmia characterized by ST elevations in precordial leads V1 to V3. It is an autosomal dominant disease, and patients are usually asymptomatic. Often the initial presenting symptom of this syndrome is syncope or sudden cardiac death (SCD). In patients with this syndrome, the only definitive treatment is the implantation of a cardioverter-defibrillator device (ICD). Previously it has been reported that Brugada type EKG patterns have been observed in patients who have used sodium channel blocking medications/drugs and in patients who are febrile. In this case, a 58 year-old male presented to our emergency department with a fever of five days duration and a non-productive cough. The patient was initially diagnosed with bilateral pneumonia, however during the initial workup his EKG demonstrated a Brugada type EKG pattern. The patient did not have any history of cardiac disease, nor was there any history of syncope or SCD in his family. The patient was eventually discharged from the hospital four days after his initial presentation and instructed to follow up with cardiology. Brugada type EKG patterns are known to occur in patients in febrile states and in those patients using certain types of medications. In those patients who present under the above mentioned conditions who are otherwise asymptomatic, the literature does not support the implantation of an ICD.