A tick-borne illness unmasking asymptomatic Brugada syndrome

Brugada syndrome is an important cause of sudden cardiac death and should be recognized in asymptomatic patients with characteristic electrocardiographic (ECG) findings. We report a case of a 59-year-old male who presented with fever and generalized malaise after a camping trip with confirmed tick exposure. Initial diagnostic work-up included an ECG, which showed incidental ST-segment elevation in the right precordial leads consistent with a type 1 ECG pattern seen in Brugada syndrome. He was diagnosed with fever-induced Brugada syndrome and treated with doxycycline and antipyretics. The type 1 ECG pattern resolved a few hours later with a resultant right bundle branch block. Implantable cardioverter–defibrillator implantation was not indicated after risk stratification. The case highlights the importance of considering Brugada syndrome in patients with characteristic ECG changes in the setting of fever, and reviews the latest criteria for diagnosis, management and risk stratification of this fatal condition.