Reference no: EM133918699

Question

D .H., a 54-year-old resort owner, has had multiple chronic medical problems, including type 2 diabetes mellitus (DM) for 25 years, which has progressed to insulin-dependent DM for the past 10 years; a kidney transplant 5 years ago with no signs of rejection at last biopsy; hypertension (HTN); and remote peptic ulcer disease (PUD). His medications include insulin, immunosuppressive agents, and two antihypertensive drugs. He visited his local physician with complaints of left ear, mastoid, and sinus pain. He was diagnosed with sinusitis and Candida albicans infection (thrush); cephalexin (Keflex) and nystatin were prescribed. Later that evening he developed nausea, hematemesis, and weakness and was taken to the emergency department. He was admitted and started on IV antibiotics, but his condition worsened throughout the night; his dyspnea increased, and he developed difficulty speaking. He was flown to your tertiary referral center and was intubated enroute. On arrival, D.H. had decreased level of consciousness (LOC) with periods of total unresponsiveness, weakness, and cranial nerve deficits. His diagnosis is meningitis complicated by an aspiration pneumonia and atrial fibrillation. D.H. has continued fever and leukocytosis despite aggressive antibiotic therapy.