Brugada syndrome precipitated by an antimalarial agent: a case report

Abstract

Background: Cardiovascular events of antimalarial treatment remain unclear, only a few studies has reported its adverse outcome. This case presentation emphasizes cardiological assessment of brugada syndrome, a rare genetic predisposed that manifest as life threatening arrhytmia occurs during routine antimalarial consumption. Without screening and untreated, this disease leads to sudden cardiac death. Case Presentation: We report a 23-year-old male initially presented with palpitation followed by syncope and shortness of breath with history of malaria infection and has switched treatment from quinidine to Dihidroartemisinin – Piperaquin (DHP). Further investigations reveal ST Elevation electrocardiogram pattern related to brugada syndrome, confirmed with flecainide challenge test. Subsequently, we stop antimalarial drug and consent to perform Implantable Cardioverter defibrilator (ICD). Initially, patients feel clinical improvement after treatment then discharged from hospital. Conclusions: Another possible cause of arrhythmic events happened following antimalarial consumption. This case highlights the possibility of proarrhytmogenic mechanism of malaria infection and antimalarial drug resulting in typical manifestation of brugada syndrome.