Introduction Multiple Implantable Cardioverter Defibrillator (ICD) shocks in a patient require thorough investigation. Acute viral infections can trigger such events, especially in patients with underlying conditions like Brugada syndrome. This report discusses a rare case of ICD shock precipitated by a viral infection in a patient with both Brugada syndrome and Marfan syndrome.

Case Presentation A 34-year-old male experienced five ICD shocks within an hour on December 6, 2022. He had a febrile illness with a low-grade fever and sore throat a week prior to the event. The patient had a history of Brugada syndrome, confirmed by a positive Flecainide challenge test, leading to ICD implantation in 2020 for secondary prevention of sudden cardiac death. He was asymptomatic with no prior device shocks. His family history was significant for Marfan syndrome, with multiple cardiac complications, including sudden cardiac death. Blood tests demonstrated normal electrolytes, and he was discharged in stable condition.

Discussion Brugada syndrome is an inherited arrhythmogenic disorder associated with an increased risk of sudden cardiac death, primarily affecting males around 40 years old. Marfan syndrome, a genetic disorder of connective tissue, often leads to cardiovascular complications. The combination of these syndromes presents unique challenges. The patient’s Brugada syndrome was unmasked by a Flecainide challenge test, leading to ICD implantation. The recent viral infection likely triggered a fever that provoked a Type 1 Brugada ECG pattern, causing ventricular arrhythmia and ICD shocks. This case emphasizes the need for prompt infection management in Brugada syndrome patients to prevent such life-threatening events.

Conclusion Acute viral infections can trigger inappropriate ICD shocks in Brugada syndrome patients. Early history-taking and device interrogation are crucial to identify causes and prevent complications. In particular, family history is vital for early diagnosis and management, particularly in young adults with a history of premature death. Thus, early ICD implantation may reduce mortality in Brugada syndrome.