Beyond the Pleura: A Case Report of Type 1 Brugada Phenocopy in the Setting of Empyema

We report a case of a 50-year-old male with a history of Hodgkin lymphoma in the neck region (in remission), ischaemic heart disease, and hypothyroidism who presented with right-sided pleuritic chest pain, cough, fever and night sweats. Imaging revealed a large right-sided loculated pleural effusion. Electrocardiogram (ECG) demonstrated a spontaneous Type 1 Brugada pattern, absent in prior recordings. Investigations ruled out intracardiac masses and the patient was treated for empyema with antibiotics and chest drainage, leading to clinical improvement. A follow-up ECG after four weeks of oral antibiotics was performed and revealed resolution of the Type 1 Brugada ECG pattern. This strongly suggested that the Type 1 Brugada ECG pattern was associated with the empyema, especially in the absence of family history or structural heart disease. This case highlights the diagnostic challenge of distinguishing Brugada syndrome from Brugada phenocopy (BrP), particularly when an infectious trigger is involved. Empyema has not been widely reported as a cause of BrP, making this a unique clinical observation. Thorough evaluation, serial ECGs, and consideration of reversible causes are essential to avoid unnecessary interventions such as implantable cardioverter-defibrillator (ICD) implantation. Right-sided empyema may represent a rare but reversible cause of Brugada phenocopy. Awareness of such presentations can aid accurate diagnosis and prevent misclassification of Brugada syndrome in acutely unwell patients.