Case 1: A 4-year-old girl presented to our emergency department (ED) during the height of summer with 5 days of left-sided facial droop, which spared the forehead. The patient also complained of severe fatigue, 1 week of frontal headaches, urinary retention, intermittent erythematous rash around her eyes and behind her knees, and an increase in night terrors. Three days before admission, she was seen by her pediatrician, who sent Lyme serologies and empirically started amoxicillin given that the patient lived in an endemic area. She notably had no known history of tick bite or rash. Lyme serologies returned negative, so the patient was referred into our ED.

The patient had 2 previous admissions to the neurology service 2 weeks and 3 weeks before the current presentation. The first presentation was for complaints of fever, urinary dribbling despite normal fluid intake, and bilateral lower extremity pain and weakness. Laboratory data including...

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