A successfully treated Brugada syndrome presenting in ventricular fibrillation preceded by fever and concomitant hypercalcemia
1Department of Emergency Medicine, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
2Department of Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
3Endocrinology and Metabolism, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
Keywords: Brugada syndrome, case report, early repolarization, hypercalcemia, multiple endocrine neoplasia type 1, sudden cardiac death, ventricular fibrillation
Brugada syndrome (BS) is a genetic channelopathy syndrome that causes fatal cardiac dysrhythmias and sudden death. Fever and antiarrhythmics are aggravating factors of BS. There are many reports about BS preceded by fever but fewer reports on BS caused by hypercalcemia (HC). Here, we describe a unique case of BS preceded by concurrent fever and HC. A 46 year old male visited the emergency department for malaise and fever. During admission, he suddenly developed cardiac arrest and ventricular fibrillation (VF). After resuscitation, electrocardiogram (ECG) showed “coved type” ST elevation in V1 and V2, which led to the diagnosis of BS. This ST change declined after the fever subsided. He also had HC at the same time. After admission, he developed septic shock. We started treatment assuming that it was caused by the aggravation of ulcerative colitis, and liver abscess was revealed on contrast enhanced computed tomography. After the infection was controlled, we implanted an implantable cardioverter defibrillator (ICD) and he was discharged. The cause of HC appeared to be an ectopic parathyroid adenoma, and calcium was normalized after tumor resection. In addition, this patient had nonfunctional pituitary adenoma and a nonfunctional adrenal tumor. His condition was indicative of multiple endocrine neoplasia type 1. This patient had BS presenting as VF induced by fever due to liver abscess and early repolarization, increasing the risk of arrhythmic events to carry out ICD implantation. HC can contribute to induce arrhythmia.
How to cite this article: Nakamura H, Sato Y, Ishii R, Araki Y. A successfully treated Brugada syndrome presenting in ventricular fibrillation preceded by fever and concomitant hypercalcemia. Turk J Emerg Med 2022;22:163-5.
Written informed consent was obtained from the patient for the publication of this case report and accompanying images.
HN, YA, and YS were involved in the initial management of this case. YS diagnosed the patient’s disease and performed ICD. RI searched for the cause of his hypercalcemia and suggested the diagnosis of MEN1. HN wrote the paper. All authors read and approved the final manuscript.
Data availability statement: None.
I would like to thank the staff at Tsuchiura Kyodo Hospital and Editage (www.editage.com) for English language editing.