Sex: U
Vaccine: MMR, VARCEL
Symptoms: Contraindicated product administered
Clinical narrative: Patient with DiGeorge anomaly (DGA) received the live measles mumps rubella and the varicella vaccine.;   This literature marketed report has been received from the authors of a published literature article, titled as stated above, concerning a child patient, with complete DiGeorge anomaly (cDGA) was suspected at birth based on absent T cell receptor rearrangement excision circles (TRECs) on newborn screening plus the presence of a ventricular septal defect and solitary kidney. Additional immune studies performed at 5 weeks of age revealed lymphopenia with very low T cells, elevated NK cells, and elevated B cells. Genetic studies revealed the presence of a chromosome 22q11.2 deletion. Genetic sequencing for Severe combined immunodeficiency (SCID) mutations was normal. Subsequent flow cytometry testing performed at 2 and 6 months of age again demonstrated very low T cells. The parents declined treatment for immunodeficiency at this time. At 13 months of age, developed fever, cough, and difficulty feeding. Chest radiograph showed a right upper lobe lung opacity. Polymerase chain reaction (PCR) of bronchoalveolar lavage (BAL) fluid revealed Pneumocystis jirovecii pneumonia (PJP). The patient was started on trimethoprim-sulfamethoxazole but continued to have fevers despite this treatment. computed tomograply (CT) scan showed significant lymphadenopathy in the chest and axillae and lytic lesions involving multiple osseous structures. A thoracoscopic lymph node biopsy showed numerous acid-fast bacilli, and biopsy culture grew Mycobacterium kansasii. Antimycobacterial therapy was started at 14 months of age with clarithromycin, rifabutin, and isoniazid. The patient was referred to Medical Center where the patient underwent cultured thymus tissue implantation (CTTI) at 17 months of age with no pre- or post-transplant immunosuppressive medications. The patient continued to have intermittent fevers. Despite extensive investigations including repeat BAL and a CTTI, no alternative etiology for the fevers was identified. Due to worsening airspace disease seen on imaging and continued fever, antimycobacterial therapy was escalated to a four-drug regimen with clarithromycin, rifampin, isoniazid, and moxifloxacin along with three weeks of intravenous linezolid. Interferon gamma infusions were started three times weekly. The patient defervesced and began to improve on this regimen. High fevers returned two months later (4 months post-CTTI), which were treated with four weeks of intravenous (IV) linezolid and IV amikacin in addition to his other antimycobacterial medications. His disease remained well controlled on oral medications after this. Flow cytometry 1-year post-CTTI revealed development of naive T cells. Patient remained on anti-mycobacterial therapy until 37 months post-CTTI. Information regarding the patient's historical conditions, concomitant therapies, and previous drug reactions or allergies was not provided.  On an unknown date, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) and varicella virus vaccine live (oka/merck) (VARIVAX) injection, both vaccines administered for prophylaxis (strengths, doses, lot #s, expiry dates and routes of administration were not provided) (contraindicated product administered).   This is one of the two cases received from the same literature article.  A copy of the published article is attached as further documentation of the patient's experience.; Sender's Comments:  US-009507513-2303USA007747: