I reviewed your revised differential. I went ahead and ordered a lumbar puncture, MRI and stains. All those results are back and I have attached them to this email.
Patient Update
Ella's condition hasn't worsened significantly, but she doesn't seem to be responding to the medication we've given her so far. Her white blood count has gone up a bit, and her temperature is a little higher than when she was admitted. Her mental status has also not improved. I would have thought that she would be responding by now, since she has already been here for 2 days.
We need to figure out what is going on. Please review the new test results and use them to revise your differential diagnosis. As you did before, look at the test results and see how they change your list of possibilities. Is anything ruled out or in based on this new information? Should the priority of diagnoses change? Then, based on your revised differential look for additional tests we can run and any new medications we should try.
This case is turning out to be more difficult than I would have thought. I'm a little worried that we're running out of time.
