Background

Brugada syndrome is a rare condition associated with increased risk of ventricular tachyarrhythmias and sudden cardiac death.1 Given its potential consequences, emergency physicians, internists and cardiologists must be familiar with the electrocardiographic features of Brugada syndrome. The typical ECG features are recognised to fluctuate,2 and are known to be revealed by several precipitants including febrile illness.3 ,4 The appearance of a Brugada-type ECG with fever may indicate an elevated risk of arrhythmia or sudden cardiac death. The following case describes the incidental ECG finding of the Brugada pattern in a patient who presented with fever and cellulitis. These findings resolved with treatment of the precipitating medical illness.

Case presentation

We report a 74-year-old, white man who presented to the emergency department with a 4-day history of fever associated with lower left leg pain, swelling and erythema. Further review of systems was unremarkable. Specifically, the patient denied any history of chest pain, dyspnoea, palpitations, syncope or presyncope.

The patient's history included hypertension, dyslipidaemia and benign prostatic hyperplasia. The patient also endorsed an episode of cellulitis 7 years prior to the current presentation that was treated with oral antibiotics without complications. His medications were rosuvastatin, alfuzosin, a combination of diclofenac and misoprostol, and vitamin D supplements. He did not report any medication allergies. He denied any significant exposure to cigarettes, alcohol or illicit substances.

His family history was unremarkable. He did not report any prior history of sudden death in relatives.

On examination, the patient did not appear to be in distress. He was febrile (39.6°C) and tachycardic (heart rate 121 bpm). Remaining vital signs were within normal limits. On the lateral aspect of the lower left leg proximal to the ankle, there was a large, non-raised, tender area of erythema with poorly defined borders, consistent with cellulitis. Cardiovascular examination revealed normal …