Age: 73.0
Sex: M
Vaccine: LYME
Symptoms: Vasculitis
Clinical narrative: Approximately 3 weeks post vax, the pt experienced iritis, followed by dermatitis and arthralgias. The iritis resolved, the dermatitis is ongoing and the arthralgias are now intermittent. Both symptoms recur. The most recent information received on 1/27/00, reports the condition of the pt is ongoing as of 1/14/00. The most recent information, received on 4/28/00, reports the condition of the pt as unknown. The follow up received on 7/27/00 states concurrent medical conditions included "arthritic shoulders," ischemic heart disease status post angioplasty, diabetes, colon cancer with persistent colostomy, and history of anemia. The pt had no previous rheumatological disorders or previous episodes of iritis. Serology testing for Lyme disease did not show any evidence of prior or concurent infection with Lyme disease. Concurrent medications include aspirin. On 5/14/99 the pt received his first injection of LYMErix. Approximately two hours later, the vaccinee had chills and sweats. He later develped a rash from his knees down which came and went, swollen leg veins causing pain, and joint swelling. Approximately three weeks alter, on 6/7/99, the pt experienced a red, painful eye and photophobia. On 6/14/99 he was diagnosed with ritis and started on steroid eye drops. He tapered down and his condition was much improved. The iritis was followed by dermatitis and migratory arthralgias. Additionally, pt complained of diminished hearing in the left ear. On 6/11/99 the vaccinee had a tick bite on his right lateral ankle. He then developed a bull's-eye rash that faded over several days and had diminished appetite (considered non-events). June 1999 physiican visits: the vaccinee had some increased dependent edema in his left leg and his sedimentation rate was noted to be elevated. For two and a half weeks in June, the vaccinee had symptoms including migratory arthralgias including the wrist, elbows, ankles, but no hot joints or effusions. Vaccinee develpoed ringing in his ears and diminished hearing which started first in his left ear and then affected his right ear without vertigo or marked balance disroder. He had develped some mild jaw discomfort. He had developed non-blanching splotchy purpuric lesions on his lower legs, right greater than left, but he stated that he had been "walking with a cane to keep pressure off his right leg, because it just felt better that way." Assessment included: 1. VAccinee had 2-3 week episode of infectious or immunologic disorder with findings of elevated sed rate, elevated muscle enzymes, CPK, SGOT and SGPT, mild anemia and possible developing vasculitis. 2. Diminished hearing with no structural ear findings, unclear relationship to tick borne diseaes, no Bell's palsy. Finding of Q-tip trauma to right ear canal. 3. Recent iritis possibly triggered by idiopathic or infectious process. Seemingly adequately responsive to tapering steroid eye drops completed approximately 6/25/99. August 1999 physician visit: Western blot and "other" serology was done, and it was concluded that the vaccinee did not have any progressive active infection. The vaccinee was told to wean the tetracycline. He had some arthralgia around the knee and left heel. He still got a few non-blanching circular lesions on his legs, but his iritis had not returned. His hearing was improved. The edema in his legs had essentially gone away and he was feeling overall much better. Assessment included: 1. Apparent immunologic response to some stimuli either Lyme diseaes or the Lyme injection with iritis and associated symptoms included hearing loss currently improving. 3. Dependent edema currently resolved although he still had some non-blanching vascular raised purple lesions scattered on his legs. 4. Mild anemia. Remains off aspirin. Vaccinee may just have a non-specific anemia of hte aged. 11/3/99 physiican visit: Vaccinee was placed on colchicios but couldn't tolerate it and discontinued. He then again was having some mild arthralgia complaints, no hot joints or swelling. He also was still having recurring prupuric lesions on his lower extremities. Assessment: 1. A post lyme vaccine by hisotry polymyalgia syndrome, possible palindromic rheumatism. 2. Elevating blood pressure. Vaccinee may have component of nephrosclerosis or vasculitis affecting the renal function. Plan: start on Cozaar 50mg once a day. 12/2/99 physician visit: the pt was seen by a different physician who felt that the pt did not have any evidence of active renal vasculitis. Complement levels were normal, creatinine clearance was 63ml per minute (normal) with a non-nephrotic range proteinuria at 148mg per 24 hrs. Vaccinee was doing well on Cozaar. He felt like his arthritic discomforts were better on colchicine which he was placed back on and could only tolerate at .6mg. Vaccinee still got small capillary hemangioma type bleed on his legs periodically that resolved over time and were replaced by new lesions. He stated that he had not gotten back to his usual lifestyles following his response to the vaccine. Assessment included: 1. Some form of palindronic rheumatism, possibly triggered by Lyme vaccination. 2. Erythematous lower extremity non-palpable purpuric lesions. 3. Pt appeared to be tolerating colchicine with some tendency toward diarrhea. 4. Hypertension. 5. Non-nephrotic range proteinuria with normal creaminine clearance. 1/4/00 physician visit: Vaccinee saw a specialist regarding his lower leg skin lesions, but he apparently had no active skin lesions on that day. 1/20/00 physician visit: Vaccinee reports that his bronchitis (non-event) was resolved. He did have some fluctuation in hearing in his left ear. He had discomfort around his right jaw and he had increased back and extremity over his lower extremities. Assessment included 1. Post Lyme vaccine arthralgia syndrome presenting at first with iritis; followed by arthralgias that tend to recur associated with recurring hearing fluctuation and recurrent apparent non-palpable, non-blanching possible vascultiis lesions. 3/20/00 physician visit. Vaccinee stated that he experienced fleeting pain anywhere on his extremities several times daily. Sometimes he had joint aches which bothered him for a day or two and then went away. He stated that he had been able to stay active and has been feeling generally pretty well. He still got occasional erythematous oval rashes on his lower extremities that came and went. Assessment included: 1. History of possible ischemic realted arthralgias, recurring lower extremity dermatitis. Continued on colchicine to try and supress a possible inflammatory chornic response to Lyme vaccine. 3/29/00 physician visit: vaccinee had a continued "flare of symptoms," burning in his ears and more rash on his legs (one lesion was biopsied). Vaccinee was no longer having headaches, and just as quickly as the symptoms flared including increased edema in his left leg and arthritic discomfort, stiffness, and swelling in his knee, the symptoms have again imroved. Physiican stated that many of the pt's symptoms were immunologically mediated. Assessment: 1. Status post biopsy lesion left leg, awaiting pathology report. 2. Inflammatory condition post Lyme titer vaccine syndrome. 3. On colchicine to supress possible inflammatory response to this stimulant. 4. Hypertension improved back on Cozaar therapy. 5/4/00 physician visit: The vaccinee continued to have arthralgias. He was not as energetic as he used to be. He had some recurring of small painful hemorrhagic skin lesions. They start out as a little tneder nodule and then form a reddish non-pitting macular and resolve over a 7 to 10 day period. A week or two may pass with no lesions an then the lesions recur. A biopsy was done and th epath report returned showing a diagnosis of leukocytoclastic amoiiris. Specialist said that no particular therapy was indicated, except for short burst of sterodis, if needed. Vaccinee continued to have arthritic joint stiffness and flares of discomforts primarily in his knees and ankles, occasionally hips. He had pre-existing history of arthritic discomforts in his shoulders that were still there. He denied any obvious joint effusion. The joints sometimes got warm, but not particularly hot, no erythema, redness, nothing to suggest active infection. Assessment: 1. Leukocytoclastic vasculitis of unknown etiology. May represent a non-specific idiopathic vasculitis. 2. Polyarthralgia, historically with onset following Lyme vaccination. The most recent info, recieved on 7/27/00 reports the condition of the polyarthralgias and leukocytoclastic vasculitis as ongoing. This report is considered as medically serious (OMIC).