Age: 50.0
Sex: M
Vaccine: FLU3
Symptoms: Amnesia, Encephalitis, Lumbar puncture abnormal, Meningitis
Clinical narrative: Pt called stating he had memory loss and hosp for encephalitis and meningitis. No further details as he was going to consult with his attorney.  12/31/2007 MR received for DOS 11/11-13/2007 with D/C DX: Aseptic meningitis; Sinusitis, ethmoid and maxillary sinuses. Pt presented to ER with onset of delirium following several days of myalgia, headache, neck pain, flashing lights, R-sided numbness and photophobia.   PE (+) for Temp 100.2'F, and loss of memory of the time pt was delirious.  Exam WNL. Rapidly improved with Acyclovir, Vancomycin and Rocephin. 02/12/2008 MR received for DOS 11/18-19/2007 with D/C DX:  Asceptic meningoencephalitis.  Pt readmitted for 2nd episode of confusion as above, accompanied by 1 week hx of night sweats, diaphoresis, fever/chills and dyspnea.  Headache with scotoma waxes and wanes but has never gone completely away.  Intermittant neck stiffness.  Continued TX with Acyclovir and D/c. Follow-up Information 12-OCT-2008: Patient, a 50 year old male, received an influenza vaccine on November 5, 2007 at a health fair sponsored by the GCRTA. Within 3 hours of the vaccine administration, he apparently began feeling ill with headache, muscle aches and a sore neck. His symptoms continued to worsen and he presented to a medical facility on November 9, 2007. He was evaluated in the emergency department there with a Head CT and was found to have sinusitis. He was treated with azithromycin and discharged. His symptoms continued to worsen and he represented on November 10, 2007 and was re-evaluated with multiple lab tests and a lumbar puncture (LP). The LP revealed abnormal fluid consistent with asceptic (non-bacterial) meningitis. The patient was treated with IV antibiotics and admitted to the hospital. The CSF cultures returned negative as did PCR tests for Herpes viruses. He was subsequently discharged from the hospital but was readmitted to the another hospital on 11/18/07. A repeat LP confirmed the diagnosis of asceptic meningitis and he was placed back on antiviral medication (acyclovir) and discharged to home the next day on acyclovir. In summary, patient had aseptic meningitis with symptom onset within a few hours of receiving an influenza vaccine. The most common cause of aseptic meningitis in the fall of the year is a virus of the enterovirus class which would fit the patient's clinical syndrome. Other causes of the aseptic meningitis syndrome include non-steroidal anti-inflammatory medications such as the naproxen or naburnetone that the patient was taking. Influenza vaccine does not cause aseptic meningitis and has been spcifically shown not to be associated with this syndrome in multiple studies. The influenza vaccine is manufactured with killed viruses so there is no chance of transmitting live influenza virus with this vaccine. In addition, the incubation period for viral (aseptic meningitis) is at least several days conforming that the patient's illness was pre-existing and unrelated to his influenza vaccine. In my opinion, with a high degree of medical certainty, the patient's aseptic meningitis was unrelated to his influenza vaccine. It is likely that he just happened to get the influenza vaccine at the time that he was incubating another virus that caused his meningitis syndrome. With respect to recovery time for aseptic meningitis: most patients recover fully within two to three weeks and can return to work without restrictions. Appropriate treatment for this condition includes intravenous fluid to prevent dehydration during the acute phase with pain medication to relieve headache. Antibiotics are not necessary since it is not caused by a bacterial organism. Antiviral medications can shorten the course of certain types of aseptic meningitis. Aseptic meningitis runs its course in 10-14 days with supportive therapy.