Fever and Hyponatremia Unmasking Brugada Pattern Electrocardiogram in a Patient With SARS-CoV-2 Infection

Abstract

Brugada syndrome is an autosomal dominant genetic disorder that primarily affects myocardial sodium channels and has been associated with an increased risk of ventricular tachyarrhythmias and sudden cardiac death. Here, we report a case of a 58-year-old Hispanic male with a history significant for prior pulmonary tuberculosis infection who presented with pleuritic left-sided chest pain associated with body aches, productive cough, fevers, and chills and was found to be positive for SARS-CoV-2 by real-time reverse-transcription-polymerase chain reaction (rRT-PCR). Electrocardiogram (ECG, EKG) on presentation demonstrated a coved ST-segment elevation in V1-V2, suggesting Brugada pattern type 1 without evidence of ischemic changes. EKG changes normalized once fever and hyponatremia improved.

Keywords: brugada syndrome; covid-19; electrocardiogram; fever; hyponatremia; sars-cov-2.

Figure 1. Initial chest x-ray showing large airspace consolidation in the left midlung which has a cavitary appearance. Biapical reticular opacities, left more than right.

Figure 2. CT showing ground glass airspace opacities bilaterally in combination with dense areas of pulmonary consolidation particularly involving the left upper lobe with the consolidation of at least half of the left upper lobe.

Figure 3. The patient’s EKG with the resolution of fever and correction of electrolytes