Age: 0.25
Sex: M
Vaccine: DTAP, HBHEPB, IPV, PNC
Symptoms: Platelet count increased, Postictal state, Pyrexia, Tremor
Clinical narrative: Eyes rolled back in head, body stiffened, arms went up like goal posts, body shook, stopped shaking for a few seconds but remained in same posture. Then repeated all for 20-30 minutes. Slept but remained in same posture for 30 minutes. Active and alert. Report all at 22:00. ER temperature was 104.5F. Hospitalized. This 2 month old apparently had his regular IZ's at 09:30 including a DPT shot. Mother had been giving Tylenol q 4h as instructed. The child had last fed about 15:00. Apparently the father was playing with the child when he suddenly became quite red in the face, then had stiffening of his extremities, both arms and legs. He seemed to be stiff for a few minutes and then the parents noted his eyes seemed to roll back in his head. He then became limp and just "went to sleep" for severeal minutes. EMS were called to the house and apparently found the pt to have a temp of 104F (rectally) and although they did not chart this on their transfer record, this was confirmed verbally by the nursing staff. The child had been feeding well today. My impression was that this child had suffered a febrile seizure and that the fever was due to his DPT shot. On the way home from the ER, the pt seemed to have another seizure and they turned around and brought him back to ER. In the ER, he continued to have at times tonic type movements, turning his head to the left and rolling his eyes. Mother states he just received his 2 month shots today. A saline lock was placed and we gave him Ativan 0.25mg IV push which resolved those type of movements and then he seemed more dazed and post-ictal. He was transferred to another hospital for septic work-up. I started Cefuroxime 275mg IV piggyback and he received fluid bolus of 10cc per kilogram. Follow up on 08/09/2001: "Patient had been in excellent health, though the mother recounts a few unusual episodes until the day he received his immunizations.  He received the immunizations on the morning of 05/30/2001.  The mother gave tylenol at 0900 and again at 1500.  About 1800, he had a peculiar episode in which he drew his arms up, became stiff and somewhat opisthotonic, and had generalized trembling.  He also had ocular deviation cephalad.  The whole episode seemed to fluctuate, and he slowly relaxed from the lower extremities on up.  When the EMS arrived, he had a temperature of 104.  He was ultimately transferred to an institution.  A CT scan was normal.  An EEG showed a right parietal spike wave focus.  LP was negative as well as routine blood studies.  The mother relates that he may have had some peculiar episodes in the past.  When he had this episode in which his head was turned towards the right at the very end and could not be readily moved she had noted that on one other occasion.  Also, several weeks ago when outside he had nother event in which he seemed to be somewhat stiff and had generalized trembling.  That also reminded her of the event that he had Tuesday.  He slept after that episode, though it was time for his nap and she thought little of it.  Thus, within the last several weeks we have two somewhat suspicious episodes, though nothing unequivocal.  he is the fourth pregnancy for this now 39-year-old, gravida 4 para 2, two living children, mother.  Her third pregnancy resulted in an older brother, then the patient.  The mother has migraine and was on Fioricet and some herbal medications during the pregnancy.  However he was active in utero.  On one occasion, they thought activity was decreased that was around the 23rd week, and as she had felt little movement for about a day, she came in for an exam.  However, at the time of that ultrasound he had decided to start moving.  she had two other ultrasounds.  There were concerns over placenta previa at the 20 week ultrasound and he had another ultrasound around 37 weeks to ensure position.  She went into spontaneous labor at term, and he was a spontaneous vertex vaginal delivery with a birth weight of around 8 pounds 3 ounces, comparable to his older brother.  The mother was group B beta strep positive.  No forceps were used.  However, although everything was felt to be going well, by 51 hours he had not urinated.  He was thus cathed.  Apparently they were suspicious about his uring and thus he was placed on IV antibiotics, though nothing ever gre