A 5-year-old previously healthy girl was taken to an outpatient ophthalmologist by her guardian due to abnormal eye movements for a few weeks. On examination she is found to have papilledema and is sent to the emergency department for magnetic resonance imaging (MRI) of the brain and orbits. She is subsequently admitted to the pediatric hospitalist service after obtaining head imaging.
Her history reveals that she had a febrile illness approximately 1 month earlier and was diagnosed as having a right otitis media at a local emergency department (ED). Amoxicillin was started, but during the following week she began to have eye movement changes, headache, clumsiness, and a stiff neck. She returned to the ED after completing 7 days of amoxicillin and was instructed to stop the amoxicillin and start cefdinir. The patient was unable to tolerate cefdinir owing to adverse effects after a trial of 3 days, and she...
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