Brugada syndrome unmasked by Plasmodium falciparum malaria and dihydroartemisinin-piperaquine treatment: a case report

Background Brugada syndrome is a rare channelopathy that can remain asymptomatic until unmasked by fever or certain drugs. Malaria, through intense fever and antimalarial treatments, represents a potential trigger; this association is rarely reported and highlights a novel diagnostic challenge in endemic areas. Case presentation A 28-year-old Moroccan man (Arab-Berber ethnicity) with no family history of sudden death presented with a 3-day febrile syndrome after a trip to Cameroon. Blood smear confirmed Plasmodium falciparum malaria (3% parasitemia). On day 1 of dihydroartemisinin-piperaquine treatment, fever (38°C) and palpitations prompted an ECG showing type 1 Brugada pattern. The pattern resolved after defervescence (day 2). A flecainide provocation test induced ventricular fibrillation, treated by external shock. An implantable cardioverter-defibrillator (ICD) was placed. The patient was discharged after favorable evolution. Conclusions This rare case emphasizes the critical need for ECG monitoring in malaria patients presenting with fever or cardiac symptoms. Fever and QT-prolonging antimalarials can unmask latent Brugada syndrome, warranting cautious drug selection and prompt electrophysiological evaluation. ICD implantation remains the cornerstone of secondary prevention in high-risk patients.