Age: 41.0
Sex: M
Vaccine: ANTH
Symptoms: Skin discolouration
Clinical narrative: Eczema-like rash starting about 5 days after Anthrax #2. He was originally for his chief complaint of an itchy rash on his arms and legs in 2/00. He did not continue follow-up visits with the Dermatology service after his 3/00 appt. and is now seeking follow-up care. He received his 1st Anthrax on 6/3/99 without incident. He received the 2nd Anthrax on 7/6/99 and shortly after, noticed some dry pruritic patches on lateral portion of both his right lower leg and his right forearm which he did not relate to his Anthrax shots at the time. After receiving the 3rd Anthrax on 8/2/99, he noticed the itching had increased and the patches spread to include areas of the left upper arm, left lower leg and the right and left thighs. The affected areas have remained the same since 10/99 with no new lesions appearing and none resolving. The appearance and size of the patches have not changed over the 2 years since onset. On 2/16/00, he was dx'd with eczema. The doctor documented that he believed the eczema was related to inflammatory process and dryness, not to the Anthrax vaccine; however, the relationship between the vaccination and the symptoms could not be excluded. He was treated with Lidex ointment 0.05% X 2 a day and ordered a punch biopsy of the left arm. The pt was recommended that the Anthrax series be put on hold until the results of the biopsy were returned and provided a temporary medical exemption for 3 months. On 3/14/00, the pt returned to the clinic with additional complaints of substernal chest pain and was evaluated and referred to the GI service to rule out gastroesophageal reflux disease. Prescriptions for both Zyrtec and Allegra were also ordered to help stop the itching but provided no relief. He was provided a 6 month temporary medical exemption from continued Anthrax vaccination due to atypical chest pain pending GI consult. After exam, he was started on Omeprazole 40mg every day, which did not relieve his symptoms. He did not return to the clinics after this workup was completed. He did however seek follow-up care with his local flight surgeon who advised him to continue with moisturizers for the eczema but that there was nothing else that could be done to help him. At this time, the patches are flat, dry, slightly scaly lesions ranging from 3-5cm in length and 2-3cm in width. They are slightly darker in color than the surrounding skin. The itchiness is most severe during the night, sometimes waking him from sleep. When he scratches the affected areas, they develop the appearance of welts and occasionally ooze. The length of time the welts are present, depends on the amount of scratching. On average, the welts generally last approx. 24 hours. This is a follow up VAERS to the 2/15 VAERS for this pt. Pt received his first anthrax vaccination on 6/3/99 without incident. He received the second anthrax vaccination on 7/6/99. Shortly after the second injection he noticed some dry pruritic patches on lateral portion of both his right leg and right forearm which he did not relate to his anthrax shots at that time. After receiving the third anthrax vaccination on 8/2/99, he noticed the itching had increased and the patches psread to include areas of the left upper arm, left lower leg, and the right and left thighs. The affected areas have remained the same since October 1999 with no new lesions appearing and none resolving. The appearance and size of the patches have not changed over since onset.