Age: 24.0
Sex: M
Vaccine: RAB
Symptoms: Blood immunoglobulin A normal, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M decreased, Double stranded DNA antibody
Clinical narrative: On 7 JUN 1971, pt was bitten on the left 3rd finger by Wind Monkey after transporting the animal to the Office. Recommendations were made for Initiation of 14 day course of Rabies vaccines. Pt recalls that on 7 JUN, approximately 6-10 hours following initial rabies vaccine receipt in his abdomen, he developed "hives in his groin area" which persisted through to the next morning (8 JUN), when he sought evaluation. He does not recall any other systemic symptoms consistent with an allergic or anaphylactic reaction. During his evaluation, he was given a shot to stop the reaction to the rabies vaccine, which patient initially referred to as an "antidote" to the purified duck embryo rabies vaccine. He was told he had an allergic reaction to the rabies vaccine, and the vaccine series was discontinued. [There was no medical records describing development of hives on 7 JUN or initial treatment for this reaction on 8 JUN.] Pt reports that within a couple hours of being treated for his allergic reaction on 8 JUN, both of his hands became red and significantly swollen to the point he could not make fists, and experienced painful finger joints. [There are no medical records describing this reaction, but there is a medical entry on 14 JUN 1971 that is partially covered by a prescription for BENADRYL 50 mg IM on 14-16 JUN] On 29 JUN 1971, on SF 89 Report of Medical History, pt noted his present health was "good, except for present reaction to rabies shot," as well reporting the following new symptoms experienced since his pre-induction Medical History In May 1968: swollen, painful joints and skin disorders, later described in Physician Summary and Elaboration of all pertinent data as "Joint's - allergic reaction to rabies shot 2 weeks ago - swollen hands" and "Skin - Reaction - see joints." On his SF 88 Report of Medical Examination dated 29 JUN 1971, the examiner noted "Flaking peeling skin - both hands." Pt was recently evaluated. After reporting his ongoing intermittent episodes of bilateral hand peeling, he was evaluated by a Dermatologist on 11 JUL 2013. Photos were reviewed by the Dermatologist who noted: "...an ongoing problem for the past 42 years and started after a reaction to a rabies vaccination that he received due to a monkey bite. He states that every 1-2 years, the skin on the bilateral palmar hands blisters and then peels; This usually happens after exposures to certain, chemical, such as garden chemicals or laundry detergent." Because pt's hands were not peeling on the day of his Dermatology evaluation, the diagnosis of "Keratolysis exfoliativa" was made based on review of photographs and reported history. The Dermatologist noted "unable to determine the etiology, but the patient notes a clear exposure history to the reaction to a rabies vaccination as well as multiple chemicals." In SEP 2013, pt evaluated by FNP at the Allergy Asthma Specialists, after reporting multiple allergies and sensitivities, as well as continual sinus symptoms. On day of evaluation, pt reported nasal congestion, postnasal drainage, sinus pain and pressure. His ROS was positive for fatigue, eye redness, itchy eyes, chronic pharyngitis, facial pain, frequent throat clearing, fullness in ears, hoarseness, nasal congestion, nasal drainage, post-nasal drainage, rhinorrhea , and sinus pressure. He was diagnosed with Non-allergic vasomotor rhinitis, history of antibiotic allery (Nitrofurantoin, Sufanillamide, Neomycin, BACITRACIN, Polymyxin B, Levofloxacin, and PCN), and selective IgM deficiency. Treatment for his vasomotor rhinitis was recommended. Regarding antibiotic allergies, desensitization was not recommended at this time as there are several antibiotic classes remaining available to be used if needed. It was recommended that if patient suffered from chronic recurrent. Infections, that further immune status work up be completed.