Meningitis and brain abscess Quiz: Ace Your Exams

A 26-year-old man presents to the emergency department for evaluation of severe headache. For the past two days, the patient has experienced constant, intensifying headaches with light sensitivity and neck stiffness. Past medical history includes type 2 diabetes mellitus and sickle cell disease. Medications include daily metformin and occasional use of oxycodone for pain management. The patient consumes 3-4 drinks per week. On review of systems, an ear infection was treated last month with oral antibiotics. Temperature is 39.4°C (103°F), pulse is 116/min, respirations are 22/min, and blood pressure is 100/65 mmHg. On physical examination, the patient is sensitive to light and resists passive movement of the neck. There is a petechial and purpuric rash on the bilateral lower extremities. Which of the following aspects of the history placed the patient most at risk for the development of the current condition?