Age: 2.0
Sex: M
Vaccine: FLU3, HIBV
Symptoms: Hyporesponsive to stimuli, Hypotonia, Impetigo, Insomnia, Intentional self-injury
Clinical narrative: 3/13-Noticable fussiness, crying; 3/18-significant crying and unable to calm, appeared to be ear pain; 3/19-took to doctor for ear pain, diagnosed acute upper respiratory infection. 3/22-Hitting himself, fear of play equipment, fear of swing, appeared to have overactive startle response.  3/23- continues to act as if ears hurt, crying often. 3/24-shortly after midnight mother wakes up and notices he had a high fever. He appears to be reaching out for mother. Upon mother picking him up appeared to be awake but limp. Mother noticed eyes moving back and forth quickly. Episode lasted less than five minutes. Mother gave him Motrin. Toddler calmed down and temperature taken, was 102. Toddler appeared to be very jerky with his movements and remained awake for 2 hours. Upon sleeping, Toddler was easily aroused and continued to have jerking movements. 3/24/14-Mother took patient to the doctor. On the way home he appeared to be extremely lethargic. At home appeared to be very confused and very irritable. Does not want to eat or drink, which is very unusual. Jerking and twitching in sleep was noted during that evening and caused severe sleep disturbance.  3/25-Symptoms and behavior remained the same-at approximately 3 pm began to break out in severe rash starting on bottom. By evening it was on bottom, face, stomach, a few on arms, hands and feet.  At approximately 1100 pm parents walked into room and noticed saliva on child's face and a circle of saliva on bedding. He was able to be awakened.  3/26-Upon awakening him, he cried for 2 hours straight. Mother took child to the Emergency room. Emergency room thought it looked like impetigo. Prescribed antibiotic ointment. Child went to sleep at 5 am. Jerky movements during sleep continued.  3/26-Took child to nurse practitioner at doctors office. Child has become increasingly irritable. He won't let others check ears, touch face, etc. NP thought it looked like strep. Prescribed antibiotics 3/28- Behavior did not improve. Returned to doctor due to continued jerking in sleep, inability to sleep, increased aggression, confusion, wanting to hang upside down, anxiety about separation from parent. Doctor referred to neurologist to have an EEG completed.  4/9/14-symptoms had improved with antibiotics as he had begun eating and drinking well again and sleeping better, but symptoms returned after antibiotics were completed. Went back to doctor. Dr's referred to Developmental Pediatrician, Geneticist, and Neurologist and EEG was moved up to occur at the end of the month.  4/14/14-Skin began to shed, especially on feet and hands. He complains of pain around toes. Toe appears to be irritated. Taken to walk-in clinic an hour away since it is Sunday. She gives more antibiotic ointment and tells us to keep it wrapped.  ****Generally there have been behavioral changes, differences in responsiveness at times, significant sleep difficulties due to limb jerk/tremors that occur throughout the night, separation anxiety, oversensitivity to sounds, aggressiveness towards others and excessive climbing/risk taking. We are continuing to look for diagnosis and treatment as it is unknown as to what caused his illness.