Age: 1.26
Sex: M
Vaccine: DTAP, HEPA, MMR
Symptoms: White blood cell count increased, X-ray of pelvis and hip normal
Clinical narrative: 2/4/10:  Pt had 15 month check-up at 2:00 PM and received the MMR, DTAP, & HEPATITIS A vaccine.  2/16/10:  Pt's mom received call from daycare provider around 3:00 PM, and she explained that Pt has a rash head-to-toe when he woke up from his nap around 2:00 PM.  She said that it looked like roseoia measles.  Mom called Dr. office around 3:30 PM and spoke to a nurse, describing pt's condition.  The nurse explained that it sounded like a possible side effect/reaction to the MMR vaccine he received on 2/4/10.  She explained that a rash like this can happen up to about 12 days after having received the vaccine.  She went on to say that it should take around 3-4 days to go away.  2/22/10:  It had now been about 6 days, and the rash was still very apparent on patients belly, back of knees, folds of elbows, back of neck, and on the back of his right thigh and bottom.  The roseoia look was still there, but it was also accompanied by darker raised red bumps as well.  Pt's mom called Dr's office around 10:30 AM and spoke with a nurse, describing patients condition.  The nurse explained that it still sounded like remnants of a possible side-effect/reaction to the MMR vaccine, and said that even though most rashes go away after 3-4 days, some can take up to 2 weeks in children.  2/24/10:  Pt's mom received a call from her daycare provider around 3:30 PM, and she explained that Pt's rash had still not gone away, that he had a fever of 101 degrees, and that he was favoring his right leg and not wanting to walk at all.  She stated that when he did try to walk, his right hip almost seemed to give out on him.  Pt's mom called Doctor's office around 3:45 PM and spoke to a nurse, describing patients condition.  The nurse scheduled an appointment with Dr. at 4:50 PM.  Patient was seen by Doctor around 5:15 PM, and the doctor witnessed patient favoring his right leg, and struggling to walk.  He also looked closely at the dark red bumps on his belly, the back of his right thigh and his bottom.  Patient's fever had risen above 101 degrees, and it was recorded in his chart.  Dr. diagnosed them as a staph infection, explaining that it looked like the same thing his two sons had, but he was concerned about his walking ability.  He explained several different things that could be causing this, and then decided to send patient to the ER to have full blood work and X-rays done.  Patient's mom, dad, and patient reported to the ER around 6:15 PM.  The lab took blood from his finger because they could not find a vain, and then x-rays were done on his right femur, hip and frog views were taken.  Results could not be shared immediately because an attending was not on duty to read the tests or films.  The parents and patient got home around 7:30 PM.  A call was received from Dr. around 8:30 PM, stating that the results had been given to him from the hospital.  He stated that patient's Sed Rate was elevated to 27, normal being 0-15, but that he wouldn't worry until it was 40 or over.  Dr. also explained that his white blood cell count was high, but that just proves that patient was fighting off an infection.  He called again around 9:00 PM to let patients mom know that patients x-rays all looked good, and that there were no fractures or inflammation in his hip.  He did say though that he wanted patient's mom to check on patient frequently throughout the night to make sure that his fever didn't climb above 102 degrees.  If it does, she was to report with patient to the ER immediately.  Dr. explained that he would like to see patient as a follow-up the next morning, and that his secretary would call to schedule an appointment.  Patient's mom checked on patient about every 2 hours to determine if his fever was rising, but it seemed to subside by around 3:30AM.  2/25/10:  Patient's mom received a call from doctor's secretary, and appointment was set for 9:50 AM.  Mom and patient reported to the appointment without a fever, and with patient being able to walk just fine and not favoring his right leg at all.  The darker red raised bumps were still present, so Dr. prescribed CLINDAMYCIN to clear up the diagnosed staph infection.  Mom was asked to use this on the red bumps and rash twice daily, and that it should take around 2 days to clear up.  2/27/10:  Patient's rash and bumps seemed to be almost completely cleared up, and just appeared faint on his skin.  Patient's mom completed his twice daily regiment just in case.  2/28/10:  Patient's mom and dad gave patient a bath around 7:00 PM, and noticed that his rash and the red bumps were back.....especially the roseoia rash on his belly.  Mom put the CLINDAMYCIN on the rash and bumps after patients bath, and placed him in clean pajamas for bed.  3/1/10:  The red bumps were gone by morning, but the rash on his belly was still pretty prevalent, as well as on the backs of his knees, folds of his elbows, and the back of his neck.  Patient's mom once again put the CLINDAMYCIN on all of the rashy areas prior to dressing his in clean clothes and dropping his off at daycare.  Mom called the daycare provider around 2:00 PM that same day to check on patient and he was just getting up from his nap.  The daycare provider stated that he was nearly rash-free, and was having a great day and was in good spirits.