16th August 2024

You are referred a 36-year-old woman who has had a seizure in the Emergency Department

You are referred a 36-year-old woman who has had a seizure in the Emergency Department. She had originally presented with severe headache and was noted to have a fever of 38.9℃ in triage. Following assessment, she was found to be having a seizure in the cubicle and was brought to resus. The seizure terminated with 5 mg of IV lorazepam. She now remains unconscious with a GCS of 6 (E1V2M3).

Her partner reports that she had been complaining of ear pain with discharge for several days prior to the onset of the headache and she had vomited that morning which prompted the attendance to the ED. She is previously fit and well.

Otoscopy reveals a bulging left tympanic membrane. Discharge is visible within the external auditory canal, and it appears purulent. CT brain imaging pre- and post-contrast shows a ring-enhancing lesion in the left temporal lobe.

Which is the single most likely organism causing this presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.