Brugada phenocopy induced by Russell's viper envenomation: resolution following anti-snake venom therapy

Russell's viper envenomation is known to cause complications such as coagulopathy, acute kidney injury and haemolysis. Cardiac involvement, though rare, has been reported in the form of arrhythmias, myocardial infarction and ECG changes such as ST-segment elevation or T-wave inversions. We report a case of a middle-aged farmer who presented to our centre with Russell's viper envenomation, characterised by local envenomation, coagulopathy, haemolysis and ocular manifestations. His ECG showed a Brugada pattern, with no evidence of any structural cardiac abnormalities or elevated cardiac enzymes. A repeat ECG performed 72 hours after anti-snake venom therapy showed resolution of the ECG findings. A diagnosis of Brugada phenocopy secondary to Russell's viper envenomation was made. The most likely mechanism causing a Brugada phenocopy in Russell's viper envenomation may be due to phospholipase A2 present in the venom, causing alteration in the cardiac voltage-gated sodium channels.