A 9 year Old Female comes to my clinic complaining for severe headaches and a stiff neck which began 2 days ago. She has had nausea and several episodes of vomiting in addition to subjective fever. Her immunizations are up to date and takes no medication. She and her guardian deny any medical history, but upon further questioning both recall a circular rash on patients lower back a few weeks ago. She has no known allergies. On examination the patient shows meningeal signs, right-sided facial muscle weakness and three 2-cm erythematous, firm plaques on her right and left flank.
Her abdomen is nontender and there is no hepatoplenomegaly. The reminder of physical examination is normal. A complete blood cell count reveals a mild lymphocytosis and comprehensive metabolic testing is normal. RPR and HIV screens negative. Hepatitis serology is normal. Which of the following should be…
