Journal of Urgent Care Medicine

Dissecting Cellulitis of the Scalp

Urgent message: Prompt recognition of dissecting cellulitis is important to help patients receive appropriate treatment and avoid long-term conse – quences such as alopecia. MOHAMED A FAYED, MD Introduction Dissecting cellulitis of the scalp is a chronic skin condition for which patients often present to urgent care providers. Prompt recognition of such cases could have significant potential benefit to patients in ensuring successful treatment and preventing complications. Case Presentation A 39-year-old African-American male presented with …

Rhabdomyolysis

Urgent message: For patients with flu-like symptoms, a careful history and examination are important to rule out more threatening diagnoses. SHRINESH V. PATEL, MD Overview In late winter/early spring, urgent care providers often encounter patients with flu or flu-like illnesses. It is easy to assume that an individual with a typical pattern of flu-like symptoms has the flu and not consider other pathologic processes.However, alternative diagnoses should always be in the differential, and careful history, …

A Slowly Healing Leg Wound

Urgent message: Clinical suspicion of CA-MRSA should be high for any skin wound or soft tissue infection with delayed healing, abscess, or persistent cellulitis. RALPH S. BOVARD, MD, MPH, and ANNE REINER, MD, MPH Introduction Caregivers need to remain vigilant and challenge diagnoses to avoid complacency in the treatment of “common” problems. We all need to foster the habit of systematic and meticulous clinical evaluation. As Goethe said: “We see what we know.” Case Presentation …

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 …

December 2012

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 …

Case Report