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A 62-Year-Old Man Is Brought to the Hospital Due to Altered

question 1626

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A 62-year-old man is brought to the hospital due to altered mental status. He has had 4 days of headaches, fever, myalgia, and chills. Medical history is significant for hypertension and a transient ischemic attack. The patient takes aspirin, amlodipine, and simvastatin. He works as horse trainer on a farm in Texas. Temperature is 38.1 C (100.6 F) , blood pressure is 108/68 mm Hg, and pulse is 98/min. On examination, the patient is drowsy. There is no neck stiffness. The lungs are clear to auscultation, and heart sounds are normal. No significant lymphadenopathy or hepatosplenomegaly is present. There is a petechial rash over the upper and lower extremities. Neurologic examination is nonfocal. Laboratory results are as follows: What is the best next step in management?

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Definitions:

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