SHM Converge Scientific Abstract ePoster Gallery-Uncovering Adrenal Insufficiency and Brugada Syndrome in a Young Patient With Covid-19

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A 25-year-old man with well-controlled celiac disease was admitted with fever, severe altered mental status, tachycardia, and later hypoxia after testing positive for COVID-19. He initially appeared too ill for uncomplicated viral infection, prompting broader workup. CT head was normal, chest CT showed pneumonitis, CSF studies were unrevealing, and toxicology and cultures were negative. He was treated with remdesivir, dexamethasone, fluids, and additional evaluation for myocarditis and encephalopathy.<br /><br />As his mental status improved, he reported months of unintentional weight loss, persistent morning nausea, fatigue, and lightheadedness. Physical exam also revealed hyperpigmentation, raising concern for primary adrenal insufficiency. Random cortisol was low at 2.3 µg/dL, and 21-hydroxylase antibodies were positive, confirming autoimmune primary adrenal insufficiency. He improved with stress-dose hydrocortisone.<br /><br />Cardiac evaluation revealed a Brugada pattern on ECG, but cardiac MRI did not support myocarditis. Given no family history of sudden cardiac death or prior arrhythmias, his short-term prognosis was considered favorable, and outpatient cardiology follow-up with loop recorder placement was planned.<br /><br />This case highlights how COVID-19 can unmask serious underlying disorders. The patient’s presentation was ultimately explained by two previously undiagnosed, potentially life-threatening conditions: primary adrenal insufficiency and Brugada syndrome. The case emphasizes the importance of avoiding diagnostic anchoring on a single infection when symptoms are unusually severe or atypical, especially in patients with autoimmune history.

Asset Subtitle

Jamal Choudhary

Meta Tag

Author List Elizabeth L. Herrle, Emma Cammann, Jamal Choudhary

Category Clinical Vignettes

Concept Primary Adrenal Insufficiency

Concept Adrenal Crisis

Concept Brugada Pattern

Concept Underlying Diagnosis

Concept Fluid Resuscitation

Distinguished Non-Finalist

Presenter Organization MaineHealth Maine Medical Center

Presenting Author Jamal Choudhary

Track Adult

Keywords

COVID-19

primary adrenal insufficiency

autoimmune Addison disease

Brugada syndrome

altered mental status

hyperpigmentation

low cortisol

21-hydroxylase antibodies

celiac disease

remdesivir

Primary Adrenal Insufficiency

Adrenal Crisis

Brugada Pattern

Underlying Diagnosis

Fluid Resuscitation