Age: 38.0
Sex: M
Vaccine: PPV
Symptoms: Cellulitis, Chills, Hypersensitivity, Leukocytosis, Pain
Clinical narrative: Cellulitis of left arm, high fever 103, leukocytosis, WBC 20,000 with Bandemia 37%; not responding to Augmentin; only responding to (unknown)Cellulitis of left arm, high fever 103, leukocytosis, WBC 20,000 with Bandemia 37%; not responding to Augmentin; only responding to ? The follow up states called MD's office on 12/24/02. Pt was vaccinated on 12/13/02 and admitted to the hospital on 12/16/02 to 12/19/02. Had blood culture 12/17/02 which showed no aerobic growth after 4d, no anaerobic growth after 6d; fungal culture not performed. Hep screen negative, anti-HAV negative, anti-HCV negative. pt is scheduled to see MD today, and will ask MD to call afterwards. Per MD: the pt received the vaccination Friday morning 12/13/02. At around 4pm, the pt had chills, pain. Pt called physician Sat. and physician saw pt. Pt had fever to 103.5 during wknd. Diagnosed with cellulitis and started on Augmentin. Couple days later, erythema had expanded beyond original outline. Leukocytosis 20K, bandemia 37%. Admitted to hospital. Had temp 102 during hospitalization. Blood cultures were performed on the day of admission and also the next day, which were negative. Had some elevation of liver enzymes but negative hep screen. Treated with vanco and clindamycin. Was seen by allergy specialist, who mentioned possible IgE mediated response, but MD thought less likely since pt had bandemia rather than eosinophilia. Pt improved, white blood cell count decreased to 5000-6000 and was discharged. At office visit today, pt afebrile. The discharge summary states allergic reaction. Reported on 02/06/2003: "Patient was admitted with diagnosis of: 1) cellulitis of the left arm related to pneumococcal vaccine, 2) possibility of allergic reaction to the vaccine, 3) high fever, 4) bronchial asthma, 5) history of allergic bronchial asthma, 6) leukocytosis and bandemia.  The patient's WCC initially was 20,000 with polys 47, bands 37 and lumphs 16%.  Urinalysis was nitrate positive.  Subsequently the WCC came down to 12.6 and the latest was 7,000.  Blood cultures so far have been sterile.  He had mild elevation of liver function tests.  SGOT and SGPT are on the high side.  INitially started with 30 and 85 and 172 SGOT, SGPT and alka phosphatese respectively.  Today's AGOT, SGPT is the same at 30, 73 and had 120 initially and now it is 102.  Urea is 8.  Creatinine is 0.9.  Sodium is 142.  Potassium is 4.4.  Chloride is 105.  CO2 is 27.  Calcium is 8.5 Phosphorus is 3. Magnesium is 2.5.  Total protein and albumin is 6.2 and 2.9.  Bilirubin is 0.4.  Blood cultures have been sterile for 2 days and x-ray of the chest showed reactive airway vs. viral pneumonitis.  The patient was advised that consultation with immunologist and also with orthopedic surgeon and was started on Vancomycin initially 1 gram q. 12 hourly and Augmentin and subsequently he was put on Clindamycin 600mg.  IV q. 8 hourly after discussing with the infectious disease consultant at the hospital.  He continued to use Combivent MDI and Tylenol prn as he became afebrile and was finally discharged.  Advise on discharge will be: Continue Clindamycin 600mg q. 8 hourly; Tylenol prn; Localized cold srayes in the area and monitor for liver function tests.  His hepatitis profile came today which was HBsAG negative, anti HBc negative and anti HCV also negative.  He is a 38-year-old male who came on Friday for a routine health care check up and also had allergic bronchial asthma.  He received a pneumococcal vaccine shot in his left deltoid region in the forenoon.  In the afternoon at about 16:00 he started having mild pain, discomfort, chills, and ultimately was running a very high fever 102 to 103 degrees Fahrenheit with increased swelling and redness in the left deltoid regoin which is progressively increasing.  Also his chest x-ray showed some hilar prominence and pulmonary bronchovascular markings.