Age: 18.0
Sex: F
Vaccine: HEPA, HPV4, MNQ
Symptoms: Fatigue, Genital lesion, Joint swelling, Lymphadenopathy, Oedema peripheral
Clinical narrative: On July, 2007 Patient received the HPV and mennicoccal vacines in preparation for college enrollment.  3 weeks after school began for Fall 2007 she started to expereice extreme fatigue and swollen glands.  4 strep tests over the next 2 months at the campus clinic all came back negative.  She continued to have some good days mixed with some bad where she could not get out of bed to attend class.  Sometime around late October she started having swelling in her ankles and feet (could not put shoes on) and pain in her elbows and wrists.  This was followed by sores and bruising on her lower legs.  A week or so later she developed sores inside her mouth and in her genital area.  During all of this time, several trips were made to the school clinic, the regional ER and trips back home to see her own doctor.  By the time she came home for Christmas in early December she could barely walk due to the  blisters and swelling/bruising of her legs and feet.  Another trip to her doctor, who recommended she see an infectious disease doctor who once he saw her referred her to another specialist.  She was diagnosed with Behcet's Disease - an auto-immune disease.  She was immediately put on steriods and another medication to keep the immune system in check.  After 7 months she is now off of the steriod but will probably have to take the other medication for the rest of her life.  I strongly believe that the vaccines she received in July attacked her immune system.  8/29/08 Reviewed PCP office records. Patient received only one HPV vaccine & it was from one of these lots: 0244U, 0389U or 0524U. FINAL DX: Behcet's disease, anemia Records reveal patient experienced  Office note of 9/28 indicates patient had fatigue, sore throat, congestion, aching & low grade fever x 3 wks & had been on oral antibiotics x 1 week w/o improvement.  Exam remealed exudate on tonsils & dx w/viral tonsillitis & anemia.  Received t/c from patient 11/1/07 following sore throat x 5 days w/temp 104.  Again on antibiotics w/o improvement.  T/C to office 12/26 Dx w/mono.  Had increasing severe joint pain, swelling of hands & feet, bruising & rash on hands & feet over 9 days.  Referred to ID.  inflammatory arthritis & recurrent genital & oral ulcers.  Tx w/steroid taper & Imuran.  8/29/08 Reviewed rheumatology records of 1/3-6/20/2008. FINAL DX: Behcet's disease w/inflammatory arthritis Records revel patient experienced recurrent oral & genital ulcers, joint pain & swelling, fatigue, erythema nodosum & skin bruising x 3 months.  Tx initially w/steroids W/significant improvement w/resolution of nodules, very mild joint pain & increased energy.  New complaint of HA & photophobia, phonophobia & nausea while on steroids & relieved only by sleep. Imuran added to tx & steroids tapered.  Has recurrent oral ulcers & increased inflammatory markers.  Steroids & imuran were increased & patient responded well.  9/5/08 Reviewed ID records of 12/27/2007. FINAL DX: Behcet's disease Records reveal patient experienced mononucleosis in fall, 2007, probable genital herpes type II & reactive arthritis symptoms.  Had completed antiviral med.