2.  Head CT Scan

Clearly something is wrong. The presence of nuchal rigidity, ptosis, leg weakness and history of fecal and urinary incontinence in an athletic young woman all suggest a potentially serious neurological problem. It is unclear how a cerebral angiogram, nerve conduction studies or a liver ultrasound would be helpful.

CT of the head showed questionable grey-white matter hyperdensities otherwise it was normal. Another important test to rule out a spinal cord lesion is an MRI of the spine. Hers was normal.

CT chest of the chest (representative image - Figure1) showed multiple small focal areas of consolidation.

Figure 1. Representative image from the chest CT scan.

Which of the following is indicated at this time?

  1. Begin Artesunic acid
  2. Lumbar puncture
  3. Bronchoscopy
  4. CT guided needle biopsy of the lung lesion
  5. Begin fluconazole

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