Age: 1.5
Sex: F
Vaccine: PNC
Symptoms: Laboratory test abnormal, Lobar pneumonia, Necrosis, Pyrexia
Clinical narrative: Follow up information pertaining to additional serious adverse events, laboratory tests and patient outcome has been received. Information regarding Prevnar was received from a physician regarding a 26 month old female patient who developed pneumococcal pneumonia, a necrotic area in left lung and small remaining empyema, pneumothorax, streptococcal infection and left necrotic lung tissue. At 18 months of age, the patient received the second dose on 5/20/03. Indication for Prevnar was immunization. Product was administered on 5/20/03. Dose regimen was 1 dose 1 time per day (IM). Patient was not taking concomitant therapy. On 1/26/04, the patient was hospitalized after several days of fever, coughing, and increased work of breathing. A chest x-ray performed on an unspecified date during this admission was read as white out of left hemothorax with mediastinal shift; the results of an ultrasound performed demonstrated pleural fluid without loculation. Cefuroxime IV was started and a chest tube was placed. A pleural fluid culture grew out gram-positive cocci and vancomycin was added to cover for possible resistant organisms. Initially, the patient improved after chest tube placement but continued to spike fevers. A CT scan performed revealed a necrotic area in the left lung, and a small remaining empyema. Repeat pleural cultures done on 1/31/04 revealed pansensitive Streptococcus pneumoniae and Streptococcus intermedius. Vancomycin was discontinued and penicillin was added to IV cefuroxime. Prior to discharge (date unspecified), the patient's chest tube was removed and she was changed to a 14-day course of Unasyn. Four days later, the patient was readmitted for pneumothorax and fever. Chest tubes were placed and a large amount of pus was drained from her left thoracic cavity. The patient was placed on clindamycin, defervesced and discharged to home with an empyema drain and oral clindamycin. On 2/23/04, the patient was seen in clinic. Her fever had improved and the chest tubes were discontinued. However, on 2/27/04, the patient spiked a temperature and experienced some increasing work of breathing. A chest x-ray showed a left lower lobe infiltrate. The patient was admitted to the pediatric surgery service on 2/28/04 for open thoracotomy with complete decortication. A chest tube was placed in the abscess cavity. Anatomic pathology confirmed left necrotic lung tissue. Post-operatively, the patient did well. Her pain was controlled with morphine PCA and transition to Lortab Elixir. The patient was continued on IV clindamycin and Unasyn, which were eventually discontinued after the patient had been afebrile for several days and her chest x-ray improved. Approximately a week post-operatively, the patient's chest tube was converted to an empyema tube. She was discharged (date not specified) on nystatin cream, Benadryl, and Lortab. Early in May 2004, the patient developed a skin infection after her Penrose drain fell out. She was treated with oral antibiotics and was reported to have done well by her primary care physician. A chest x-ray performed on a subsequent follow up physical exam showed a small amount of inflammation and/or fluid in the right lower lobe area; this was unchanged since her prior chest x-ray. A chest CT was scheduled to look at her lung in more detail. It was noted that if the fluid collection resolved, antibiotics would be stopped; if it persisted, therapy would continue for approximately two weeks, followed by observation. The patient was reported to have recovered.