Makayla, a 16-Year-Old Girl with Fever and Blurry Vision

Abstract

CASE PRESENTATION Makayla is a 16-year-old girl who presents to the emergency department (ED) with fever and blurry vision. Upon presentation, she is febrile and ill appearing with concerning neurologic changes, including gait instability, difficulty starting her urine stream, and difficulty swallowing, leading the ED physician to obtain a computed tomography (CT) scan of the head, comprehensive metabolic panel, complete blood cell count, C-reactive protein (CRP) level, and a blood culture. Makayla’s head CT scan and all of her laboratory tests are within normal limits, and the ED physician orders a normal saline bolus and a dose of ibuprofen. The ED physician is concerned about Makayla’s constellation of symptoms and feels that she needs further infectious and neurologic workup, and he calls you to evaluate Makayla for admission.