Age: 19.0
Sex: M
Vaccine: MNQ, MNQ
Symptoms: Hyporeflexia, Myalgia, Polyneuropathy, Sensory disturbance
Clinical narrative: Initial report received from a physician on Oct 04 2005. An 18 year old male patient received a first dose of Menactra, lot number U1656AC, in the left deltoid on Aug 08 2005. The route of administration was not reported. 25 days later, the patient began to experience weakness and numbness in his left and both feet. He was seen by the reporting physician on Sept 07 2005 and was referred to a neurologist, he was seen by the neurologist on Sept 16 2005 and it was noted that the patients initial symptoms had progressed and he began to experience weakness, most notable in his legs, but also manifesting in his hands as decreased dexterity. He described having difficulty running and feeling that when he walks he is off balance secondary weakness. The patient felt that the symptoms were for the most part symmetrical, but stated that the impaired dexterity was somewhat worse in his left hand. He denied any antecedane infection, including upper respiratory illness or gastrointestinal symptoms. he had travels numerous times to Mexico, but did not report any acute illness associated with travel. he reports no recent sick contacts, he reported possible having a mosquito bite, but is unaware of any other contacts with animals or insects, he denied any autonomic symptoms including lightheadedness, abnormal sweating or changes in urination. Since the development of his symptoms he received an adjustment by a chiropractor two times with out significant improvement. A review of the patients systems was notable for muscle soreness, most notably in his thigh. A neurological examination was significant decreased sensation to light touch, pinprick and temperature in a stocking/glove distribution. His strength was noted to be 5+ with the exception of 4+ in this right and left deltoid and his left and right iliopsoas. his gait was slightly hesitant and he was unable to tandem. His reflexes were 2+ with the exception of 0+ in his right and left Achilles. It was reported that several serologic studies ordered by the patients physician were unremarkable. After seeing a neurologist, the patient was scheduled for EMG nerve conduction studies, lumbar puncture, MRI of the spine, cell count, protein, oligoclonal bands, IgG index and West Nile titers. A variety of serologic studies, including antibodies for Guillain Barre and various entities that may be associated with the patients symptoms was also to be completed. no results were provided. Based upon the patients history and physical examination, it was thought that the patient appeared to have evidence of subacute/acute polyneuropathy, There was no clear precipitant for the development of his symptoms. While some features of his examination were somewhat inconsistent with this entity, acute inflammatory polyneuropathy, aka Guillain Barre syndrome, was thought to be a probable diagnosis. it was also planned to work the patient up for West Nile virus, although the neurologist felt that the patient's conditions would be very inconsistent with this diagnosis, The patient was admitted to the hospital. At the time of this report, the patient was recovering at home.