title: Fever-triggered Brugada syndrome in an adult patient presenting with hemophagocytic syndrome induced by Chlamydophila pneumoniae.
abstract: A previously healthy 29-year-old man was admitted to our hospital, with a 4-day history of fever (>39°C), rigours, diaphoresis, fatigue and retro-orbital headache. On examination, he was febrile (37.8°C) and tachycardic (110 bpm). Laboratory work up revealed bicytopenia (white cell count 1.37×10(9)/L, platelets 60×10(9)/L) and an increase in C reactive protein (9 mg/dL). The ECG showed ST segment elevation in V1, V2 and V3 leads. The patient was admitted and investigation was initiated revealing prolonged fever (>7 days), pancytopenia, hepatosplenomegaly, hyperferritinemia, hypertriglyceridemia, hypofibrinogenemia, elevated soluble CD25 and hemophagocytosis in bone marrow. Therefore, the patient presented 7 of the 8 diagnostic criteria of hemophagocytic syndrome. Laboratorial investigation for infectious causes was negative, except for IgA and IgG Chlamydophila pneumoniae. ECG re-evaluation on the day of discharge showed no ST segment elevation and no other abnormalities. Genetic testing for known mutations associated with hemophagocytic syndrome and Brugada syndrome did not show any mutations in these genes.
authors.affiliation: Nephrology Department, Hospital Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Miguel Bigotte
authors.initials: MB
authors.lastname: Vieira
authors.affiliation: Internal Medicine Department, Hospital Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Gaibino
authors.affiliation: Pathology Department, Hospital Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Pignatelli
authors.affiliation: Internal Medicine Department, Hospital Santa Maria-Centro Hospitalar Lisboa Norte, Lisbon, Portugal.
authors.forename: Anabela
authors.initials: A
authors.lastname: Oliveira
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001853:Bone Marrow / Q000473:pathology; D053840:Brugada Syndrome / Q000209:etiology* / Q000382:microbiology; D023521:Chlamydophila Infections / Q000175:diagnosis* / Q000188:drug therapy; D016993:Chlamydophila pneumoniae; D004318:Doxycycline / Q000008:administration & dosage; D004562:Electrocardiography; D005334:Fever / Q000209:etiology; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000209:etiology* / Q000382:microbiology; D008297:Male; D012720:Severity of Illness Index
chemical_list: D000900:Anti-Bacterial Agents; D004318:Doxycycline