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Background Wolff-Parkinson-White (WPW) syndrome is a congenital abnormality of the cardiac conduction system characterized by the presence of an accessory pathway, which can predispose affected individuals to supraventricular tachycardia (SVT), atrial fibrillation, ventricular fibrillation, and sudden cardiac death. Despite its clinical significance, WPW syndrome is often underdiagnosed, particularly in resource-limited settings where cardiac arrhythmias may be misattributed to other conditions. Case presentation We report an eight-year-old Nigerian girl with WPW syndrome who was repeatedly misdiagnosed and managed for malaria over four years before an accurate diagnosis was established. She presented with recurrent episodes of chest discomfort, generalized weakness, nausea, and near-syncope. Each episode was treated as malaria, and symptoms resolved following treatment. During the most recent episode of the symptoms, she received care in a tertiary centre where SVT was identified following an electrocardiogram (ECG), heart rate was persistently about 250 beats per minute. Initial pharmacologic intervention with intravenous amiodarone was ineffective, necessitating external cardioversion to restore normal sinus rhythm. A post-recovery ECG confirmed a Wolf Parkinson White pattern. Conclusion WPW syndrome remains a diagnostic challenge in paediatric populations, where it can masquerade varying diseases, resulting in misdiagnosis. This case underscores the importance of a high index of suspicion for cardiac arrhythmias in children presenting with unexplained recurrent symptoms. Early recognition and appropriate intervention are crucial in preventing life-threatening complications associated with WPW syndrome. Increased awareness among healthcare providers can lead to improved diagnostic accuracy and better patient outcomes.

Summary Background Lipid and electrocardiographic (ECG) abnormalities have been reported in adults with sickle cell anaemia (SCA) and may reflect underlying structural and/ or functional damage. However, the relationship between ECG and lipid abnormalities among children with sickle cell disease is not fully understood. Objectives To compare the steady-state lipid and ECG abnormalities in children with SCA to the controls and examine the hypothesis that lipid abnormalities are closely related to electrocardiographic abnormalities, and therefore are a reflection of cardiac damage among these children. Methods: Clinical, laboratory and ECG profiles of 62 children with SCA and 40 age- and gender-matched haemoglobin AA controls were compared. The influence of clinical characteristics, lipids profiles, markers of haemolysis, and renal and hepatic dysfunction on ECG pattern in children with SCA was then determined. Results The patients had lower average diastolic and mean arterial blood pressure, total cholesterol and low-density lipoprotein cholesterol (LDL-C) levels than the controls, (p = 0.001, 0.002, 0.000 and 0.000, respectively). The mean triglyceride level was significantly higher (p < 0.001), while high-density lipoprotein cholesterol (HDL-C) levels were comparable (p = 0.858). The cases were about six times more likely to have left ventricular hypertrophy than the controls (OR = 6.4, 95% CI = 2.7–15.6, p = 0.000). Haematocrit level had a negative correlation with QTC (r = –0.3, p = 0.016) and QT intervals (r = – 0.3, p = 0.044). Triglyceride levels had a positive correlation with the PR interval (r = 0.3, p = 0.012), while serum alanine transferase (ALT) concentrations had an inverse correlation with PR interval (r = –0.3, p = 0.015). There was no statistical difference in the sociodemographic and clinical characteristics of the SCA children with or without ECG abnormalities. However, the mean triglyceride and serum ALT levels in those with ECG abnormalities were significantly higher than those without (p = 0.007 and 0.045, respectively). Conclusion Lipid and ECG abnormalities are common in children with SCA. Elevated triglyceride and serum ALT levels are possible biochemical markers of ECG abnormalities in these patients.