1. PATIENT PRESENTATION
A 57‐year‐old Chinese man presented to the emergency department with fever, cough, and atypical chest pain. He had no medical history of note. At triage, his temperature was 101.2°F (38.4°C). His physical examination was unremarkable. His white cell count was normal, but he was both lymphopenic and thrombocytopenic. High sensitivity troponin I was not elevated. The patient's 12‐lead electrocardiography (ECG) at triage is shown (Figure 1).
FIGURE 1.
Initial electrocardiography (ECG) in triage. Arrows highlighting the rSR’ pattern with coved ST‐segment elevations in leads V1 and V2
2. DIAGNOSIS
The ECG is consistent with a type 1 Brugada ECG pattern. It demonstrates an rSR’ pattern with coved ST‐segment elevations both in V1 and V2 (Figure 1). Given a positive contact history with COVID‐19 cases, the patient was isolated given the clinical suspicion of COVID‐19 pneumonia. His nasopharyngeal swab for COVID‐19 RNA polymerase chain reaction testing returned positive. He was managed supportively with supplemental oxygen, and was discharged after 20 days (Figure 2). His ECG showed normalization of ST‐segment elevations once afebrile (Figure 3).
FIGURE 2.
Chest radiograph on the left was performed on admission. Chest radiograph on the right was repeated on day 2 of admission when the patient turned hypoxic. Arrow highlighting new infiltrates from COVID‐19 pneumonia
FIGURE 3.
Repeat electrocardiography (ECG) when the patient was afebrile in the general ward. Arrows highlighting normalization of ST‐segment elevations
To the best of our knowledge, this is the first reported case of a type 1 Brugada ECG pattern unmasked by COVID‐19 pneumonia. Brugada syndrome is more prevalent within Asia than in Europe or the United States. 1 Several factors such as certain drugs, increase in vagal tone, and fever can unmask the type 1 Brugada ECG pattern. 2 Our patient's presentation to hospital with COVID‐19 pneumonia allowed for opportunistic diagnosis of an asymptomatic type 1 Brugada ECG pattern, and he has since been advised on avoiding specific medications, excessive exercise, and reducing fever. 3
CONFLICTS OF INTEREST
The authors have no conflicts of interest to disclose.
Koo CY, Chan PF, Ong HA, Kojodjojo P. Man with fever, cough and atypical chest pain. JACEP Open. 2020;1:306–308. 10.1002/emp2.12076
Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
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