Case Reports

Urgent Message: Recurrent or unexplained periorbital ecchymosis (“raccoon eyes”) in an infant should prompt consideration of metastatic neuroblastoma and escalation for appropriate imaging. Alejandro Lopez, BS; Julia Gamache, BS; Ella Weiss, BS; Aaron J. Maki, MD, PhD Keywords: neuroblastoma; metastatic neuroblastoma; periorbital ecchymosis; orbital metastasis; suprarenal mass; pediatric malignancy Abstract Introduction: The presenting symptoms of pediatric neuroblastoma are highly variable. Patients may first present to urgent care for what they perceive as a minor complaint …
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Urgent Message: Nitrous oxide-associated peripheral neuropathy may present similarly to Guillain-Barré syndrome, and clinicians are encouraged to conduct a careful clinical assessment of patients with neurological symptoms. Ivan Koay, MBChB, MRCS, FCUCM, FRNZCUC, MD; Cameron Olphert, BSc (Hons), MSc Keywords: nitrous oxide toxicity; vitamin B12 deficiency; peripheral neuropathy; myeloneuropathy; Guillain-Barré syndrome; paresthesia Abstract Introduction: Although often regarded as “safe,” repeated exposure to nitrous oxide can result in serious neurological sequelae, most notably functional vitamin B12 …
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Urgent Message: Necrotizing fasciitis may present without visible soft tissue abnormalities. Therefore, clinical signs and symptoms—including localized pain and tachycardia—are findings that should warrant further clinical investigation. Abstract Introduction: Necrotizing fasciitis (NF) is a severe, rapidly progressing soft tissue infection. Early NF may present to urgent care without visible soft tissue abnormalities. As such, clinical signs and symptoms, including localized pain with tachycardia, should warrant further clinical investigation. Case Presentation: A 43-year-old male presented to …
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Urgent Message: Adrenal crisis is uncommon in the urgent care setting, but it can be rapidly fatal if diagnosis is missed. Early administration of hydrocortisone and fluid resuscitation with correction of electrolyte abnormalities are essential to reduce mortality. Clayton R. Halford, PA-C Keywords: adrenal crisis; adrenal insufficiency; Addison disease; hypoglycemia; hyperkalemia; pediatric endocrine emergency Abstract Introduction: Adrenal (Addisonian) crisis is a rare but life-threatening endocrine emergency that can present to urgent care with nonspecific symptoms …
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Urgent Message: Behçet disease may present atypically in non-endemic regions, and ocular involvement requires urgent specialty evaluation to prevent irreversible vision loss. James McClellan, BS; Kimberly M. Rathbun, MD, PhD, MPH Keywords: vision loss; retinal vasculitis; panuveitis; Behçet disease; branch retinal artery occlusion; branch retinal vein occlusion Abstract Introduction: Behçet disease is a multisystemic inflammatory disease affecting large, medium, and small blood vessels that has an unpredictable and recurrent pattern. Behçet disease has a wide …
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