Coved and Saddleback ST-Segment Elevations: Brugada Phenocopy vs Brugada Syndrome

We report a case of a middle-aged man who presented with near syncope, fever, and dysuria and was incidentally found to have coved ST-segment elevations in leads V1 and V2 confirming Brugada type 1 ECG (electrocardiogram) pattern. This ECG pattern morphed into saddleback ST-segment elevations in precordial leads consistent with type 2 Brugada the following day. Additionally, the patient reported a positive family history of sudden cardiac death. This initial presentation made it impossible to differentiate Brugada phenocopy (BrP) from Brugada syndrome (BrS). Continuous cardiac monitoring was initiated, electrophysiology consulted and fever managed with antipyretics. The patient was diagnosed with prostatitis and bacteremia from E. coli and managed with antibiotics. There were no electrolyte abnormalities nor was the patient on any medications other than tamsulosin for his chronic benign prostate hypertrophy. Once the fever resolved the patient's ECG returned to normal, thus confirming the diagnosis of BrS on day 3 post-admission. Differentiating between BrP and BrS requires ruling out possible underlying causes and determining if resolution in ECG patterns occurs.