Can you guess the diagnosis of this 17-year-old male with loss of consciousness during a febrile illness?

Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then visit our website on Wednesday at 12:00 PM ET for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Simone Hunter, MBBS; and Orhan Kilinc, MD.

The case

A 17-year-old male with a history of asthma presented with loss of consciousness during a febrile illness. He reported being in his usual state of health until the previous day, when he developed a fever associated with nasal congestion, cough, sore throat, and fatigue. His symptoms worsened throughout the morning, prompting him to leave school early. Later that evening, after sleeping, he experienced syncope while getting up to use the bathroom and was found on the floor in front of the shower by his sibling. The syncopal episode reportedly lasted less than a minute.

Prior to the syncopal event, he noted nausea and palpitations, but denied chest pain, dyspnea, lightheadedness, dizziness, or seizure-like activity. There was no postictal confusion, headache, or bleeding from the ears, nose, or throat. Family history was notable for the absence of sudden cardiac death or known Brugada syndrome. Emergency medical services transported him to the emergency department.

On examination, the patient was alert and oriented. Vital signs were significant for fever with a temperature of 38.4 °C and an elevated blood pressure of 152/86 mm Hg. He had copious nasal secretions, but respiratory and cardiac examinations were otherwise unremarkable. Neurologic examination was also normal.

An ECG performed in the emergency department revealed a type 1 Brugada pattern, prompting cardiology consultation. Transthoracic echocardiography demonstrated normal right ventricular size and systolic function, with mild thickening of the left ventricular posterior wall, attributed to increased body habitus. Left ventricular ejection fraction was 69.2%, and troponin and BNP levels were within normal limits.