Surviving the Death Roll; Unveiling the Undiagnosed: Case of Hispanic Man with Covid-19 Pneumonia

Brugada syndrome (BrS) is an inherited electrophysiological abnormality which typically manifests in patients with diverse ethnicities as ventricular arrhythmias or sudden cardiac death. The onset is frequently unmasked by various precipitating factors including but not limited to febrile diseases. Severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infection and associated COVID-19 illness continues to evolve. We are reporting a severe case of Covid-19 infection unveiling the undiagnosed Brugada syndrome, and the complicated course requiring mechanical ventilation and rounds of Cardiopulmonary resuscitation. A 57-years-old Hispanic man with no known prior cardiac history presented to the emergency department with fever and altered mental status. Initial investigations revealed mild leukocytosis, and positive SARS-CoV-2 PCR. The patient was transferred to intensive care unit (ICU) due to hemodynamic instability and electrolyte derangements. On day 2 of ICU stay, patient became febrile, hypotensive, tachycardic, and his hypoxemia worsened with increased supplemental oxygen requirement. His electrocardiogram (ECG) was consistent with atrial fibrillation and covedtyped Brugada pattern. At the early hours of the subsequent day, patient developed first episode of asystolic cardiac arrest requiring cardiopulmonary resuscitations (CPR) and intubation leading to return of spontaneous circulation (ROSC) after 10 mins. Only 3 days after the initial cardiac arrest episode, patient suffered from another episode of asystolic cardiac arrest requiring CPR leading to return of normal sinus rhythm and ROSC. Patient had a successful recovery from COVID-19 pneumonia with no additional cardiac events during his hospitalization, and was subsequently extubated and discharged from hospital with close follow up monitoring. Reported cases of Brugada syndrome in Hispanic population are scarce. Covid-19 positive patients have a guarded prognosis when they require intubation with mechanical ventilation with no chances of survival when they suffer cardiac arrest requiring cardiopulmonary resuscitation. This stimulated us to report a case of Brugada syndrome presented in Hispanic man who recovered a deadly course of Covid-19 infection despite requiring intubation and complicated course by two rounds of cardiopulmonary resuscitation (CPR).