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The Brugada syndrome is the result of a cardiac sodium channel mutation and results in characteristic electrocardiographic (ECG) changes. It can lead to ventricular fibrillation and sudden cardiac death. Growing evidence suggests that certain drugs or medical conditions can unmask the Brugada syndrome in a patient with previously normal ECGs and no cardiac history. We report on the fourth case of Brugada syndrome precipitated by lithium. This report emphasizes the fluctuating nature of Brugada-type ECG changes and the need for emergency physicians to recognize that the syndrome can be a dynamic entity on ECG.