Brugada syndrome precipitated by uncomplicated malaria treated with dihydroartemisinin piperaquine: a case report

Malar J. 2024 Sep 17;23(1):283. doi: 10.1186/s12936-024-05099-3.

Abstract

Background: Cardiovascular events following anti-malarial treatment are reported infrequently; only a few studies have reported adverse outcomes. This case presentation emphasizes cardiological assessment of Brugada syndrome, presenting as life-threatening arrhythmia during anti-malarial treatment. Without screening and untreated, this disease may lead to sudden cardiac death.

Case presentation: This is a case of 23-year-old male who initially presented with palpitations followed by syncope and shortness of breath with a history of malaria. He had switched treatment from quinine to dihydroartemisinin-piperaquine (DHP). Further investigations revealed the ST elevation electrocardiogram pattern typical of Brugada syndrome, confirmed with flecainide challenge test. Subsequently, anti-malarial treatment was stopped and an Implantable Cardioverter Defibrillator (ICD) was inserted.

Conclusions: Another possible cause of arrhythmic events happened following anti-malarial consumption. This case highlights the possibility of proarrhytmogenic mechanism of malaria infection and anti-malarial drug resulting in typical manifestations of Brugada syndrome.

Keywords: Antimalarial drug; Arrhythmia; Brugada syndrome; Electrocardiogram; Heart disease; Malaria.

Publication types

  • Case Reports

MeSH terms

  • Antimalarials* / adverse effects
  • Antimalarials* / therapeutic use
  • Artemisinins* / adverse effects
  • Artemisinins* / therapeutic use
  • Brugada Syndrome*
  • Electrocardiography
  • Humans
  • Malaria / complications
  • Malaria / drug therapy
  • Male
  • Piperazines
  • Quinolines* / adverse effects
  • Quinolines* / therapeutic use
  • Young Adult

Substances

  • artenimol
  • Antimalarials
  • piperaquine
  • Artemisinins
  • Quinolines
  • Piperazines