Brugada syndrome unmasked by fever

A 32-year-old man presented with high fever, cough and sore throat. He was seen on the second day of his febrile illness after he experienced a “fainting spell”. He felt thumping in his chest and then fell into unconsciousness. Minutes later, he recovered spontaneously. His elder brother, aged 35 years had died of a “fast irregular heart rhythm”. Physical examination was unremarkable and his temperature was 39°C. An Electrocardiogram (ECG) was taken. The ECG manifests Brugada type 1 coved pattern in V1-V3 (A, B). There is a pseudo-right bundle branch block. At the end of QRS, there is a ST segment elevation (STE) of ≥2mm in V1 and V2. The STE is followed immediately by an oblique rectilinear downsloping ST which terminates in a small T wave inversion. Serial ECGs over 4 days showed reversal of abnormalities with defervescence. On Day 3 (C), the temperature fell to 37.7°C and the Brugada type 1 coved pattern had evolved to the type 2 saddleback pattern. On the fifth and sixth day of his illness (D,E), the right precordial leads had normal morphology. Cardiac enzymes and electrolytes were normal.