Sepsis related Brugada syndrome in community acquired pneumonia due to Legionella pneumophila: a case report

Background: Legionella pneumophila is a cause of community-acquired pneumonia (CAP). Brugada syndrome (BS) is a rare channelopathy. Fever can unmask electrocardiographic pattern of Brugada. Case presentation: A 67-year-old patient presented with high fever and acute hypoxemic-hypocapnic respiratory failure. Chest High-Resolution Computed Tomography revealed pneumonia in the left lower lobe. The urinary antigen test was positive for Legionella pneumophila. A diagnosis of CAP was made. Interestingly, the electrocardiogram (ECG) performed during pyrexia showed a type 1 Brugada pattern. This result was confirmed with more specific high precordial leads ECG. Ischemic heart disease was ruled out by serial dosages of troponin and echocardiogram. The CAP was successfully treated with antibiotics against Legionella pneumophila. Since fever can induce the potentially harmful Brugada pattern on ECG, high doses of antipyretic drugs were introduced. After discharge, the patient was referred to a specialized centre for the diagnosis and management of genetic heart disease, where he was evaluated by expert cardiologists, arrhythmologists, and geneticists. Conclusions: We reported the first case of BS unmasked by septic status and fever secondary to Legionella pneumophila CAP. In cases of pneumonia and fever, healthcare providers should be vigilant in recognizing ECG signs of BS to prevent the adverse outcomes associated with the disease.