Brugada Syndrome Associated With Adolescent Loperamide Abuse

Pediatrics. 2018 Oct;142(4):e20181423. doi: 10.1542/peds.2018-1423.

Abstract

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 on an 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. 5038G>A, 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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Analgesics, Opioid / adverse effects
  • Antidiarrheals / adverse effects*
  • Brugada Syndrome / chemically induced*
  • Brugada Syndrome / diagnosis*
  • Brugada Syndrome / genetics
  • Humans
  • Loperamide / adverse effects*
  • Male
  • Mutation, Missense / genetics
  • Obesity / diagnosis
  • Obesity / drug therapy
  • Obesity / physiopathology
  • Substance-Related Disorders / diagnosis*
  • Substance-Related Disorders / genetics

Substances

  • Analgesics, Opioid
  • Antidiarrheals
  • Loperamide