Meningitis (pediatrics) Quiz: Ace Your Exams
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An 8-year-old girl is brought to the emergency department by her parents due to 2 days of high-grade fever, headache, and vomiting. Her parents note increasing drowsiness and irritability. Past medical history is unremarkable. She has not received her routine vaccinations. Temperature is 39.2°C (102.6°F), heart rate is 110/min, respiratory rate is 22/min, blood pressure is 95/65 mmHg, and oxygen saturation is 98% on room air. The patient appears lethargic but is arousable. Skin examination does not reveal a rash. Fundoscopic examination shows bilateral papilledema. Neurological examination reveals neck stiffness and involuntary knee and hip flexion upon neck flexion. She moves all extremities equally in response to painful stimuli. Initial laboratory evaluation reveals leukocytosis with a white blood cell count of 15,000/µL (reference range: 4,500-13,500/µL), a C-reactive protein (CRP) of 40 mg/L (reference range: < 3 mg/L), and an elevated procalcitonin level. Blood cultures are pending. Which of the following is the best next step in management?
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