zaki
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A 34-year-old white woman with rheumatoid arthritis presents to the emergency room with a 4-day history of fever, frontal headaches, and difficulty thinking. She has taken amoxicillin for about 24 hours for suspected sinus infection. She has not slept well for the past 2 nights because of the headaches. Her current medications are ibuprofen and prednisone. On physical examination, she has a temperature of 38.8 °C (101.8 °F), joint findings consistent with rheumatoid arthritis, short-term memory deficits, and drowsiness; there are no focal neurologic deficits, papilledema, or nuchal rigidity.
Laboratory studies reveal a leukocyte count of 15,500/µL, a plasma glucose of 112 mg/dL, and a serum sodium of 135 mg/dL. A radiograph of her sinuses reveals mucosal thickening in the frontal sinuses but no air-fluid levels. A lumbar puncture is done, revealing the following: Leukocyte count
162/µL (78% lymphocytes)
Glucose
62 mg/dL
Protein
74 mg/dL
Lactate
20 mg/dL
Gram stain
No organisms seen
Rapid bacterial antigen tests
Negative
Routine culture
No growth
Which one of the following statements is true about this patient?
(A) Her normal cerebrospinal fluid lactate concentration rules out a diagnosis of bacterial meningitis.
(B) It would be reasonable to withhold antimicrobial therapy, while observing the patient, pending culture results.
(C) Computed tomography of the head should be done.
(D) Bacterial meningitis cannot be reasonably excluded because of her prior antibiotic use, so empiric antimicrobial therapy should be instituted to complete a full standard course for bacterial meningitis.
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Maverick
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is it D
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The answer is B ???
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