Age: 65.0
Sex: F
Vaccine: YF
Symptoms: Joint swelling, Malaise, Muscle atrophy, Musculoskeletal stiffness, Neuropathy peripheral
Clinical narrative: I am almost 66, have always had a healthy, active lifestyle; have been energetic & chipper - hard to keep me down, some favorite activities being aerobics, strength-training, & gardening. Thus, when I realized how my body crashed one morning, I couldn't believe what was going on. Let me begin by recounting how I am presently feeling, after my 14-week "mysterious illness." It is difficult walking; I have much weakness & fatigue; stiffness, aches, & pains all over my body, which get somewhat better as the day progresses; cannot reach with my hands; cannot make a fist; shaky hands as I extend them; painful wrists. I have lost about 12 pounds [24 pounds total after 6 months following the June 11 "crash"], much of which is probably muscle that has atrophied. The confusion has not totally left me, after all this time. Just two nights ago, I realized that I do not have to "fix" my dreams before getting out of bed (of course, I knew that before this "crash.") Even before this" fixing my dreams" thing, I didn't think I COULD get out of bed, but was glued to it. I thank my God that the confusion is leaving, gradually, & that I will be well soon. For our trip (June 19-29), we were told that we needed a yellow-fever immunization (which we later found out we didn't need) to enter the country, and received the immunization on June 10. Fourteen hrs. later I awoke with tremendous pain & immobilization. Could not raise my arms, great difficulty walking. This was followed by total sleep disturbances, unbelievable confusion, bizarre nightmares. We realized after about a week that it very well could be related to the yellow-fever immunization. We went, thinking I'd be better any day, but was sick the whole time there. (Saw a doctor there, who gave me a prescription a little stronger than ibuprofen. I followed up with my intern, who refilled the prescription, and offered to me to see a specialist, a rheumatologist, which I didn't right then.) Eventually (Aug. 18, 28, & Sept 10) I saw a homeopathic physician & am presently under his program of vitamins & amino acids - but believe that my "mysterious illness" is deeper than this - we want your second opinion. At our 1st visit Dr. put me through a "Non-invasive Autonomic Nervous System Monitoring," which he had developed, which showed a tremendous imbalance in my system. At this time, my blood pressure was low, pulse high, & prolonged low-grade fever. I was sent home with much lab work to be done, including sending into the lab hair samples for metals, much blood work done (18 vials), 24-hour-urine sample, stool sample. At our 2nd visit, he went over the results of the lab tests that had come in, which included the fact that I was anemic, not producing protein, have neuropathy, have mono, possible Lyme, & metals from the hair samples, and put me on a regimen including THE BASIC SIX (which I am still taking, as of this date): B12 sublingual (20 mg) +50 mg folic acid drops daily; 86 (200-400 mg); Magnesium (600-900 mg); Ascorbate (about 4,000 mg); Taurine (3,000 mg); plus AMINO ACIDS: Methionine (1, 000 mg); N-Acetly-l-Cysteine (1,200 mg); 03 (4, 000 IU); Black Walnut (3mL); BCAA - Leucine (4,000 mg), Isoleucine (2,000 mg), Valine (2,000 mg); Co-Enzyme Q 10 (200 mg); Platinum Plus protein digestion enzyme; Turmeric (800 mg); Endura/PakGuard; prescription Midodrine HCL (5 mg); another antibiotic ZITHROMAX; a third antibiotic MEPRON ($1,500 per bottle before insurance - a total of three bottles). Plus I am taking supplements from my supply: multivitamins, Osteomatrix, Osteo Bi-Flex. I have been monitoring my blood pressure (low), pulse (high) & temperature (low-grade fever, usually) for about 3 weeks. During this time I awoke one morning (Sept. 4) with horrible dizziness, clamminess, & just feeling weak and awful. An ambulance took me to the Emergency Room, where I spent over 9 hours. They did a salt water IV, lab test, EKG, measured my oxygen level, & urinalysis, triage. They sent me home, & told me to have follow-up for this illness. From the beginning, my ankles began to swell, and got much worse as the weeks progressed. I am currently wearing support hose (20/15, I believe), which seem to be helping my circulation & lowering the swelling somewhat. I don't know how this relates to the neuropathy I have. April 10- Subsequently, I have left Dr. care and am being treated by a rheumatologist, Dr. His diagnosis is totally different (opposite) from other Dr., and the nature of my medical prescriptions has totally changed. I am now taking Prednisone (3 mg), Hydroxychloroquine (400 mg), and using cream for my rash (Triamcinolone Acetonide Cream USP, 0.1%). (Other former medications which were discontinued because of undesirable side-effects are Methotrexate, Leucovorin, and Nystatin.) Attached is a letter from Dr., testing to the relationship between the Yellow Fever immunization and my present condition. According to Dr., the prescribed medications will not cure the illness, but only lessen the symptoms. In fact, recently the symptoms have returned with a greater intensity, and Dr. believes I will never be cured from the illness. I have seen 10 physicians, and have an appointment with the 11th next week. April 18- I have seen the "liver" doctor - and upon her request have scheduled an MRI of the abdomen (liver) and a liver biopsy. Have had additional blood work from the laboratory. Will send those results when I receive them.  4/28/09 Received medical records provided by patient from homeopathic internist (labs only), rheumatologist, & travel clinic (labs only). FINAL DX: SLE (cutaneous) initiated by YF vaccine; cholestatic hepatitis probably secondary to lupus; postmenopausal osteopenia.   Rheum records of 11/26/08-3/11/2009  reveal patient experienced fever & muscle/joint pain, significant morning stiffness, low grade fever beginning approx 16 hr s/p YF vaccine.  24# weight loss.  When seen intially, had diffuse, red pruritic rash for few days, discomfort, difficulty w/ADLs, extreme fatigue, recurrent chills, dry mouth, sore throat, joint swelling, depression, nightmares, confusion, markedly decreased sensation in feet.  Was on 29 supplements & 4 antibiotics when initially evaluated.  Appeared fatigued at initial eval, had synovitis in mutiple joints, decreased sensation in feet, pedal edema bilaterally.   Referred for ID, Neuro & Derm consults.  RTC 2/10/09.  Neuro w/u was WNL.  Rash continued w/steroid dose increased. Continued synovitis of hands.  Referred for skin biopsy & tx w/Plaquenil.  RTC 3/11/09  w/improved s/s but continued synovitis of hands/fingers & improved rash.  Steroids tapered & started on ASA. Referred to Hepatology.  5/4/09 Received medical records from Travel Clinic & Inf Disease 9/16-9282008. FINAL DX: FUO, anemia, iron deficiency, CA125 elevation. Records reveal patient experienced fever of unknown origin, fatigue; weakness; myalgias; stiffness in multiple joints; heaviness of arms; confusion, nightmares & chills nightly x 2 mo; pitting edema of hands/feet.  Had foreign travel 6 wks prior to onset of symptoms returning home 4/24/08.  Symptoms began approx 1 mo after her return home then received YF vaccine 6/10/08.  Approx 12 hr s/p YF vaccine, developed acute weakness, achiness & stiffness, daily low grade fevers.  Had second episode of foreign travel w/continuation of symptoms & severe fatigue & generalized weakness.  Beginning 9/4/08 awoke w/acute dizziness, N/V & low blood pressure; seen in ER tx w/hydration & d/c to home improved.  On 9/16 patient reported improved sleep, decreased energy, stiffness in joints & muscles, low grade fever, 14# wt loss,  but nightmares/conofusion had resolved.