Journal of Urgent Care Medicine

Hodgkin Lymphoma

Urgent message: Close follow up is necessary for pediatric patients with vague presentations, lest a diagnosis of childhood cancer be missed. JANET D. LITTLE, MD Introduction This case presentation reflects the challenge of diagnosing childhood cancers in a timely and accurate way. The presenting signs and symptoms are oftentimes nonspecific and can mimic those of common childhood conditions.1 The frequency of delayed diagnosis for childhood cancers is high, and reflects the importance of close follow-up …

Chronic Exertional Compartment Syndrome

Urgent message: Runners who train too much too soon risk serious injury. Prompt and thorough evaluation is necessary to spot CECS masquerading as “shin splints.” MATTHEW SPEER and JOHN SHUFELDT, MD, JD, MBA, FACEP Overview Running is one of the world’s most popular exercises, with millions across the globe participating and training for events from 5K races to ultramarathons of over 100 miles. Despite the fact that more than 10 million people run over 100 …

Methicillin-Resistant Staphylococcus aureus

Urgent message: Accurate, early diagnosis and appropriate antibiotic treatment of MRSA is essential to prevent subsequent morbidity and mortality. SAMINA YUNUS MD, MPH, and DONNA GOETSCH, MSN, CNP Case Presentation A 22-year-old white female presents to the urgent care clinic with a complaint of an infected spider bite on her left upper thigh. She first noted a pimple-like lesion approximately a week before presentation. The lesion has subsequently grown and developed a central, black area …

Stevens-Johnson Syndrome

Urgent message: Early diagnosis is crucial in patients with this rare – but potentially fatal—condition. RACHEL CETTA, BSBE, MSBE, and JOHN SHUFELDT, MD, FACEP Overview Stevens-Johnson Syndrome (SJS) is a rare and potentially life-threatening condition. While the exact etiology is unclear, SJS often is associated with an adverse drug reaction to an assortment of drugs ranging from nonsteroidal anti-inflammatory drugs (NSAIDs) to anticonvulsants.1 SJS involves blistering and sloughing off of necrosed skin, leaving a burn-like …

An Old Condition Presents New Challenges

Urgent message: Acute rheumatic fever is not common but it does still occur, underscoring the need for head-to-toe examination in patients with vague symptoms that seem unconnected. HEATHER VARLEY, PA-C, and WILLIAM GLUCKMAN, DO, MBA, FACEP Introduction Patients with fever, sore throat, and malaise often present in the urgent care setting and they typically are worked up quickly with a rapid strep test or given a diagnosis of a viral syndrome. The case described here …

Ludwig’s Angina

Urgent message: Thoroughly evaluate patients who complain of dental or oral pain. CHRISTOPHER MCKENNA and JOHN SHUFELDT, MD, JD, MBA, FACEP Ludwig’s angina is a serious and potentially life-threatening connective tissue infection found on the floor of the mouth and in the deep neck spaces. More specifically, it is a bilateral infection of the submandibular space. The two compartments affected are the sublingual space and the submylohyoid space.1 This condition usually presents in individuals who …

Infectious versus Inflammatory Flexor Tenosynovitis: A Little, Big Problem

Urgent message: Infectious flexor tenosynovitis is an orthopedic emergency that can cause long-lasting disability through tendon necrosis and permanent digital contracture if unrecognized or mismanaged. MARY A. LANE, MD Flexor tenosynovitis is an inflammation of the tendon sheath that can be caused by either introduction of infection or various inflammatory conditions ranging from autoimmune arthropathies to crystal joint depositions. Flexor tenosynovitis caused by infection is an orthopedic emergency. It can cause long-lasting disability through tendon …

Abdominal Pain of Unusual Origin in a Teen

Urgent message: Always be mindful of the ‘zebra’ in a stampede of ‘horses’ in the differential diagnosis. ELISABETH L. SCHEUFELE, MD, MS, FAAP Case Presentation J.H. is a 19-year-old Hispanic male presenting with abdominal pain and shortness of breath for the last 4 days. He had visited the urgent care clinic about 2 days before with similar symptoms and was discharged with a diagnosis of muscle strain. J.H. returned with persistent symptoms and he indicates …

High-Risk Conditions Presenting as Back Pain (Part 4)

Urgent message: Back pain with incontinence and focal neurological changes are red flags for serious conditions. ERICA MARSHBURN, BS, BA, and JOHN SHUFELDT, MD, JD, MBA, FACEP Low back pain is a common presentation in the urgent care setting and it is important for providers to be aware of signs and symptoms that could indicate a more serious condition than nonspecific muscular pain. Be sure to make a thorough evaluation of your patients and pay …

Drug Toxicity Following Trip to the Local Head Shop

Urgent message: Thorough work-up is mandatory for patients with mild symptoms from recent use of “bath salts” because of the potential for multi-systems failure. JOHN K. GRANDY BS, MS, RPA-C Case Presentation A 19-year-old male is brought to an urgent care clinic by his mother, who states that her son and his friends took “Molly Mosquito Caps” 2 days ago that were purchased from a local head shop. The patient and his friends all experienced …