Age: 45.0
Sex: F
Vaccine: LYME, LYME
Symptoms: Neuralgia, Neurological examination abnormal, Pain, Shoulder pain
Clinical narrative: Report 2001001167-1 describes brachial plexitis and herniated nucleus pulposus of the thoracic spine (T3-T4) with radiculopathy in a 45 year old female who received Lymerix. On 07/01/99 (left deltoid), 08/02/99 (left deltoid) and 10/12/00 (site nos), the patient received her first, second, and third doses of Lymerix, respectively. On an unspecified date "earlier in the year", the patient experienced back pain and hip pain. On 10/14/00, the patient developed a "burning, painful" paresthesia of her upper chest and right arm. She was able sleep at night only when she placed her right arm above her head and off to the side. To the patient's recollection there was no prior trauma and she had no repetitive activity the day before or even the week before these symptoms began. On 10/15/00, the pain moved into the right side of her back involving the shoulder blade area. She did not have shortness of breath. She was seen by her physician later that day, and the diagnosis of inflammation of the chest wall was made. Her skin seemed very sensitive at the time. She was treated with Nabumetone (Relafen) and Dextropropoxyphene / paracetamol (Darvocet), which seemed to ease the discomfort somewhat. She stayed home from work the next three days. Her medications were changed at this point to Oxycodone Hydrochloride (Percocet) and Famcyclovir (Famvir). The patient was evaluated by her physician, who identified no objective findings consistant with nerve or muscle injury. Her ESR, CRP, and RF were all normal. On 10/23/00, the patient was evaluated by an orthopedic surgeon, who excluded a thoracic outlet syndrome. The diagnosis of "muscular skeletal pain" was made. On 11/03/00, the diagnosis was changed to costochondritis and neuropathic pain. She was treated with Oxycodone Hydrochloride (Percocet) and Lidocaine patches. Neither of these helped. A neurologist diagnosed brachial plexitis, rule out cervical radiculopathy, rule out thoracic radiculopathy. On examination, "the only bothersome finding" is the subjective decrease to pinprick on the right between T2 and T5. The neurologist prescribed Methylprednisolone (Medrol Dosepak). The patient received treatment with NSAID's (nos), Doxycycline, and Famcyclovir (Famvir), all without improvement. Gabapentin (Neurontin) has lessened the pain only slightly). On 12/20/00 she under went an MRI of the brain with and without contrast which was normal. A bone scan on 12/06/00 was also normal as well as a rib x-ray on the same date. An MRI on 11/20/00 yielded evidence of a tiny posterior T3-T4 herniation indenting the ventral aspect of the spinal cord in the thoracic region. On 12/27/00 and 01/15/01, the neurologist stated that the 11/20/00 thoracic MRI finding "might result in some radicular complaints and it is possible that this lesion is responsible for some of the patient's symptomatology." "At the time of the patient's last examination on 12/04/00", the neurologist stated, "there was no evidence of long track involvement that would suggest a spinal cord myelopathy." The EMG / nerve conduction study right demyelinization of the right median and ulnar nerve between Erb's point and the axilla. Diagnosis: 1. Right brachial plexitis. 2. Herniated nucleus pulposus of the thoracic spine (T3-T4) with radiculopathy. The patient felt that her symptoms were related to Lymerix. The treating physician was "not so sure". The case is considered incapacitating because the patient has been unable to work. As of 01/24/01, the outcome of the events is ongoing.