Age: 1.4
Sex: F
Vaccine: FLUX, FLUX
Symptoms: Irritability, Mouth ulceration, Nervous system disorder, Neurological decompensation, Nuclear magnetic resonance imaging brain abnormal
Clinical narrative: Initial report was received from the literature article on 08 July 2014. The following is the verbatim for the full text article: A 16-month-old, previously healthy girl presented with fever for 2 days. Other symptoms included rhinorrhea, cough, decreased activity, and oral ulcerations associated with decreased oral intake. The child had no vomiting, diarrhea, rashes, head trauma or other injuries. There were no sick contacts. The child's father denied home medications and ingestions. Immunizations were up to date and included her first influenza vaccine. In triage the child had a temperature of 39.8 degrees C, pulse of 164 beats per minute, respiratory rate of 20 breaths per minute, and oxygen saturation of 98%. She appeared tired and irritable but was consolable. She was given ibuprofen (10 mg/kg/dose). As the child was placed in the examination room, she became unresponsive with rightward eye deviation, drooling, and symmetric tonic-clonic seizure activity. The seizure continued for >10 minutes despite rectal diazepam (0.1 mg/kg/dose) and concluded after intravenous midazolam (0.1 mg/kg/dose). She was also given acetaminophen (15 mg/kg/dose per rectum). A 20-minute postictal period was followed by a second 10-minute seizure, which required intravenous (IV) midazolam (0.1 mg/kg/dose) and a load of IV fosphenytoin (20 mg/kg/dose). Following treatment with anticonvulsants for persistent seizures, the patient's neurologic status failed to improve to baseline. The child was intubated for a Glasgow Coma Scale score of 7 and was transferred to a PICU. A head CT was positive for areas of hyperattenuation, likely representing blood but nonspecific; therefore, additional studies, including an MRI and a lumbar puncture, were obtained. The MRI showed restricted diffusivity within the bilateral posterior frontal and anterior parietal lobes, consistent with viral encephalitides with tropism for these regions of the brain. Sparing of the basal ganglia decreased the likelihood of a toxic/metabolic insult. Additionally, a vascular etiology was less likely due to the symmetry and normal appearance of the vessels in the magnetic resonance angiography/ venography. The lumbar puncture showed 25 white blood cells and 32 700 red blood cells (RBCs) per high-powered field. CSF was subsequently positive for HSV polymerase chain reaction (PCR), with later serologic confirmation for HSV-1. MRI findings, along with the positive HSV PCR, were consistent with the diagnosis of HSE. The patient was initially treated with IV ceftriaxone (100 mg/kg/dose), vancomycin (15 mg/kg/dose), and acyclovir (20 mg/kg/dose), but later the antibiotics were discontinued, and the patient completed a 21-day course of intravenous acyclovir (20 mg/kg/ dose, 3 times a day). The child's seizures recurred and proved difficult to treat. She was discharged to a chronic care facility after a 9-day hospital stay. At the time of discharge, she had significant   [Due to memory limitations, the remainder of this text could not be compared.]  ficant neurologic impairment but was continuing to make slow progress in physical and occupational therapy. The list of documents held by sender: none.