Age: 30.0
Sex: M
Vaccine: ANTH, TDAP, TYP
Symptoms: Skin lesion, Visual acuity reduced, Visual field defect
Clinical narrative: Following vaccine receipt, pt developed: On day of vaccine - developed welt at anthrax vaccine site (2-2 1/2 inches) with redness, tenderness, warmth and swelling surrounding site (resolved within 10 days); on 7/3/07, developed achiness of neck, back and shoulders, malaise and felt feverish the next day (fatigue persists). On 3/7/07, developed new onset bilat knee pain. One week after vaccine receipt developed new onset right elbow pain and about 3-4 weeks after vaccine receipt, developed new onset wrist pain and later developed hand pain and cramping. On 7/5/07, developed several skin lesions (chest, forearm, shin, cheek and penis; developed oral lesion later in July; has had subsequent lesions on genitalia, mouth, chest and forearm. Developed decreased vision and blind spot in left eye in August 2007; had decreased vision in left eye again in Dec 2007 and Feb 2008, which was diagnosed as optic neuritis. In March 2008, had visual changes and pain affecting both eyes and diagnosed as retrobulbar optic neuritis. Diagnosed in May 2008 with Behcets syndrome. Admitted in early May for bilat pulm emboli. Between August 2007 and March 2008, pt was also evaluated for Paraparesis, ataxia, and falling with recurrent optic neuritis, which was worrisome for MS (MS has since been ruled out).  5/28/2008 MR received from Ophth consults dated 4/4-5/19/2008 with DX: Post-vaccine Autoimmune Optic Neuropathies. Worsening by 4/25/08.  Additional DX of Behcet's Disease. Started on Immunosuppression tx by rheumatologist.  Improvement noted by 5/19/08./pc 06/17/2008 MR received for 4 admissions and several ER visits between 12/22/2007 and 5/4/2008. D/C DX 12/24/07: Retrobulbar neuritis.  HTN.  Inflammatory Bowel. D/C DX 01/19/2008: Dysarthria, etiology unclear.  ? Dx of MS.  HTN.  Dyslipidemia.  Hx of L ventricular hypertrophy. D/C DX: 3/02/2008:  Optic neuritis s/p high dose steroids. MS. HTN.  Hyperglycemia. Hyperlipidemia. D/C DX 5/8/2008:  Optic Neuritis of L eye, resolving.  Orthopnea 2' to Pulmonary embolism. Bilateral PE.  Hx of Bechet's or Behcet's-like syndrome.  GERD.  Acute on chronic pain syndrome.  Insomnia.  Anxiety Disorder.  Asthma.  Pt initially presented from ophthomologist's office with DX: Retrobulbar neuritis for IV steroid tx.  Pt had sudden onset of a Left blind spot, blurry vision, and eye pain. Similar episode 7/2007. Tx with Solumedrol with complete resolution of sx. Admitted again 1/17/2008 with c/o Acute febrile illness, difficulty speaking and MS exacerbation.  presented with slurred speech, tingling of L side of face and arm and difficulty walking.  Pt c/o pain in the back, neck, skin, face, jaw.  burning pain on forehead and cheeks. Random patches of numbness and tingling. Pt also c/o chest pain, SOB, nausea and urinary and fecal incontinence. Sx of dysarthria improved and pt d/c home. Admitted again 2/26-3/2/2008 with dx of optic neuritis for IV steroid tx. Admitted again 5/4/08 for L eye blurriness accompanied by dizziness and lightheadedness.  he then developed SOB and weakness and was admitted through the ER.  PE noted on CT angiogram.  Started on anti-coagulation tx.  Rheumatology consult with ? etiology of the recently dx'd Behcet's as 2' to anthrax vaccine.