Brugada Phenocopy Induced by a Lethal Methanol Intoxication

Brugada phenocopies (BrP) are clinical entities that present with an ECG pattern identical to either the type 1 or type 2 Brugada pattern without true congenital Brugada syndrome. This ECG pattern is associated with an identifiable condition and normalizes upon resolution or treatment of the underlying cause. We present a case of a 54-year-old man with extreme metabolic acidosis, hyperkalaemia and a Brugada type 1 ECG pattern in the setting of a suicidal methanol (MeOH) poisoning. Upon correction of these metabolic derangements with bicarbonate infusions and continuous veno-venous haemodiafiltration (CVVH), the Brugada type 1 ECG pattern normalized. Unfortunately, the patient developed signs of cerebral herniation followed by brain death and died on the first day of ICU admission. LEARNING POINTS: Brugada-like ECG patterns are described in several metabolic conditions such as extreme hyperglycaemia, glucose/insulin challenge, isolated hyperkalaemia or in association with hyponatraemia and acidosis. Until now, there have been no published case reports of BrP in association with methanol intoxication. Correction of hyperkalaemia and acidosis and specific therapy for methanol intoxication leads to a complete resolution of a Brugada type 1 ECG pattern.