Age: 52.0
Sex: M
Vaccine: FLUX
Symptoms: HIV antibody negative, Lumbar puncture, Nuclear magnetic resonance imaging normal, Paraesthesia, Salivary hypersecretion
Clinical narrative: Shot adminstered at work. A week after shot, I began to have difficulty swallowing. The difficulty increased and visited doctor on 12/1.  On 12/2 was ordered to go to hospital for tests and feeding. Remained in Hospital for 23 days to test for cause. None diagnosed. After 3 weeks at home, went to clinic for second diagnosis. Again no set diagnosis, was given medication to take care of symptoms (double vision, facial tingle, and increased salivation.) Clinic decided to call it Cerebral Encephilitis. Said time was the only thing that would cure symptoms.  5/21/09 Received Neuro consult for 1/20-1/27/2009. FINAL DX: suspected brain stem inflammatory syndrome; hyperactive gag reflex due to same; dysphagia w/PEG tube; right trigeminal motor neuropathy; probable pseudobulbar palsy; fluctuating allodynia w/vomiting; diagonal double vision, normal neuro-ophtho exam. Records reveal patient experienced pain & tingling of right thigh w/raised rash.  Saw PCP 10/08 & dx w/zoster flare.  Tx w/antivirals.  Initially improved but the recurred about 6 wks later, tx again w/antivirals.  On 11/21 had choking spell that progressed in frequency & severity until by Thanksgiving very difficult to swallow.  On 11/30 while burning shrub, developed pain & tingling of head & neck, ear redness & nausea which subsequently became daily episodes when even a breeze was painful.  Developed facial rash w/o blisters in 12/08.  Saw PCP & tx w/antibiotic but was unable to swallow pill or even drink H2O.  Admitted to hospital on 12/3.  25# wt loss, hyperactive gag reflex, chills, sleeping sitting up due to choking sensation, anxiety, voice changes, phlegm, persistent double vision, ear fullness, recent thrush, 1 episode SOB.  Neuro-ophtho consult done & WNL.  EMG revealed right trigeminal motor neuropathy.  Facial reflexes very hyperactive c/w pseudobulbar dysfunction.  3/12/09 Received PCP medical records of 12/1/08-2/4/2009. FINAL DX: encephalitis of unknown cause affecting only brainstem; severe dysphagia. Records reveal that on 12/1/08 patient experienced sore throat, facial kin tingling, facial tightness/pressure, itching eyes/nose, difficulty sleeping, voice changes, HA & fever x 1 wk.  Was recovering from w/shingles pain although no vesicles.  RTC 2/4/09 s/p hospitalization x approx 1 mo where he received plasmapheresis.  Currently having facial tingling & difficulty swallowing, neck tension pain, generalized weakness, weight loss, feeding tube insertion & was going to swallow therapy & PT.  3/30/09 Received hospital medical records of 12/3-12/25/2008. FINAL DX: neurogenic dysphagia, unknown etiology; malnutrition requiring PEG placement. Records reveal patient experienced progressive dysphagia approx 12 days prior to admit, w/HA & facial pain/tingling after recent bout of presumed shingles(no rash).  Tx w/antivirals & steroids.  Feeling unwell x 2 mo.  No reactions to prior flu shots.  Neuro & ENT consults done, both of which were WNL.  Oropharyngeal video revealed aspiration.  Received plasmapharesis x 5 for possible GBS variant w/minimal improvement.  Able to manage secretions w/suctioning & d/c to home w/tube feedings w/Neuro & ENT f/u.