Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is characterised by fever, rash, eosinophilia and organ damage that develops 2-6 weeks after the initiation of a medication. We report a case of DRESS syndrome in a 79-year-old man that developed after the introduction of rifabutin, ethambutol and clarithromycin used to treat Mycobacterium avium complex (MAC) vertebral osteomyelitis. This case highlights treatment and management challenges in a patient with known MAC vertebral osteomyelitis requiring prolonged steroids. Steroids are the mainstays of treatment for moderate to severe cases of DRESS syndrome. Initiation of steroids for the treatment of DRESS syndrome among patients with concomitant infections requires multidisciplinary collaboration for optimal management.

A pregnant woman presented with increasing exertional dyspnea and was found to have complete heart block with a junctional escape rhythm. The complete heart block did not resolve with exercise testing, suggesting infranodal disease. A presumptive diagnosis of mild viral myocarditis was made, having been exposed to her toddler with a viral exanthem days before. After giving steroids to preemptively accelerate fetal lung maturity and several days of close observation, the AV block resolved. She was discharged in stable condition without need for temporary or permanent pacing and later delivered a healthy infant.

| 473 FISER Et al.This Doppler signal reflected increased turbulence across the obstructed bronchus, which was detected due to conduction of ultrasound through the pulmonary consolidation. In normal lung tissue, ultrasound would be attenuated by air. This phenomenon represents a Doppler equivalent of "vocal fremitus" elicited by physical examination of a patient with an underlying lung mass or pneumonia. A similar phenomenon has been used in breast ultrasound clinically to characterize mammary tumors as malignant vs benign. 1,2 However, Doppler fremitus findings from an intrathoracic pulmonary consolidation have not been described.These images illustrate the range ambiguity of continuous wave Doppler and the inadvertent detection of extracardiac abnormalities during an echocardiography. Careful attention to the timing of Doppler abnormalities along with an understanding of Doppler physics is necessary to avoid misdiagnosis.

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