Short-coupled variant of torsade de pointes

In April 2007, a 36-year-old man was admitted to our hospital because of fever (40 °C), dizziness and stomach ache. His previous medical history revealed primary sclerosing cholangitis (PSC, 2005), epilepsy (1985) and a mild colitis for which no medication was used. The epilepsy was diagnosed in 1985 by several consecutive EEGs. On admission an exacerbation of the PSC was diagnosed and endoscopic retrograde cholangiopancreaticography was performed. The day after admission, the patient collapsed while in the toilet. Resuscitation was started and the automated external defibrillator, attached by the nurses, delivered one shock re-establishing circulation. The patient was admitted to the coronary care unit. In his childhood the patient had experienced seizures, the last syncope, however, was about 20 years before. His family history was negative for sudden cardiac death. The patient was taking ursodiol (for PSC), valproic acid (for epilepsy) and on admission ciprofloxacin (200 mg twice daily) was added. Apart from fever and a painful abdomen, the physical examination showed no (cardiovascular) abnormalities. …