Brugada syndrome associated adolescent loperamide abuse

We present the case of a 14-year-old boy with obesity, hypertension, and chronic loperamide abuse who presented to our facility with symptoms of opioid withdrawal and type 1 Brugada pattern o electrocardiogram. He was treated for anxiety and withdrawal. There were no documented dysrhythmias. His Brugada pattern resolved by hospital day 5 and remained resolved 12 days postadmission. Genetic testing revealed a heterozygous missense mutation in the SCN5A gene (c. 5038GA, p. Ala1680Thr), which has been reported in association with Brugada syndrome. To date, there are no published reports of pediatric loperamide use associated with a Brugada pattern on an electrocardiogram. We propose that chronic loperamide use unmasked the electrocardiographic phenotype associated with his gene mutation.