حمى+اقياء +تصلب النقرة +.......بشو منفكر؟

Complicated otitis externa with menengitis?

Next step: NP?

I don't think that otitis externa can lead to menegitits in a week.

اي ها ,هلأ بينت...

so ,your diagnosis is partitially right,and your next step is right also...

and it is meningitis because of the clinical findings ,and from the history of the patient we find that he went to a "swim pool" which makes me think of Naegleria fowleri which con lead to meningitis in one week and can lead to death if the patient untreated ,so the next step that I would make is Gram stain and a CSF exam to make sure of my diagnosis ....

Gram stan in this case would be negative ....

so I will start with rifampicine and mecanazole

in one week also

Naegleria is a very rare cause of disease is America. There were only 24 cases of human infection between 1989 and 2000,All of the people who have lived from the parasite were on Ampho B (6 of 24 in the US)