Age: 1.5
Sex: F
Vaccine: VARCEL
Symptoms: Cellulitis, Dermatitis bullous, Difficulty in walking, Herpes zoster, Labia enlarged
Clinical narrative: Information has been received from a medical technologist concerning an 8 year old female patient who at five years of age (approximately 2001) was vaccinated with a dose of varicella virus vaccine (lot number not available). The medical technologist reported that recently the patient was diagnosed with herpes zoster rash. She was hospitalized primarily because of extreme pain associated with the rash with many vesicular lesions. The patient has since been discharged from the hospital approximately one week ago. The medical technologist reported the patient was recovering. She indicated the hospital had collected three cultures at three different times, and would like the culture which grew VZV sent to the VZV identification program for viral identification via PCR. It was noted that the specimens were positive for DFA. The medical technologist also mentioned that she was not sure about the diagnosis of herpes zoster since the child is reported (although it had not been seen by medical technologist) to have wide spread non-dermatomal distribution of lesions. No other information was available. There was no product quality complaint reported. Follow up information received from a physician reported that the patient's rash started on 12/28/03 and her first emergency department visit was on 12/30/03. On 1/1/04 she was hospitalized with Zoster of S2-S3 distribution with greater than 100 lesions in the dermatomes and greater than 50 lesions elsewhere on the body. The physician reported that the patient's pain was described as a 10 on a pain scale of least (0) to most (10), and the patient was admitted for pain relief. It was reported that the patient couldn't walk at first due to extensive perineal swelling of right labia and inner thigh. The patient was started on acyclovir and antibiotics. The patient was afebrile. A viral direct antibody and culture were positive for varicella zoster virus. A white blood cell count was 32 and hematocrit was 35. On 1/1/04 a vesicle type lesion specimen (isolate in MRC-5) was obtained and sent to the laboratory for testing on 1/12/04. The results amplified varicella zoster virus DNA and the specimen strain revealed wild type varicella zoster virus. The patient was hospitalized four days and she recovered. The physician also reported that the patient did not have a recent exposure to chicken pox or herpes zoster, but she had been exposed to varicella as a baby (less than one month old) when her three siblings had varicella. It was noted that the patient had been breast fed and was not ill. Additional information has been requested. Follow up information received on 03/08/04 states: "Follow up information provided by a medical technologist indicated that the pt's culture was sent in "quite some time ago". She also mentioned that she did not know the pt's primary care physician. Additional information has been requested." Follow up information received on 03/22/04 states: "Follow up information received on 03/04/04 from a physician indicated that the reporter has tried contacting the primary physician to obtain more information. Additional information has been requested." Additional followup information received from a physician indicated that the rash did not occur at the site of injection post-vaccination. There was no history of chickenpox. There was no recent exposure to chickenpox or herpes zoster. Medication included intermittent momestasone furoate (NASQNEX) for allergies. A direct flourescent antibody was done and was positive. No phone was taken. Laboratory results are listed below. On 27-Dec-2003, the child started with the onset of itching. She then developed a vesicular rash on her labia bilaterally which spread to her inner right thigh and right buttocks. The child was started on acyclovir and antibiotics on 28-Dec-2003. She presented to the emergency room on 30-Dec-2003, and given Keflex and cream. On 31-Dec-2003, the rash persisted and the pain increased to the pont where it was difficult for her to walk. On 01-Jan-2004, she was admitted to the hospital for pain relief wand IV antiviral therapy for VZV. Medical records indicated that the patient tested positive for varicella zoster Ag. Acyclovir was started on 01-Jan-2004 (also reported on 28-Dec-2003), and the ceftriaxone was stopped on 01-Jan-2004. The nafcillin was stopped on 02-Jan-2004. The lesion cultures from 31-Dec-2003 grew 1 + diptheroids. The patient was improving with the IV acyclovir, and was instructed to go home on oral therapy. For pain, the patient was treated with acetaminophen (+) codeine phosphate (Tylenol with Codeine) every 6 hours as needed. The discharge diagnosis was cellulitis. There were no procedures, therapy or surgery. There are no pending lab results. Upon discharge, the patient was prescribed hydroxyzine hcl 10 mg tabs (1 tablet by mouth every 6 hours), codeine/spap #3 1 tablet (1 tablet by mouth every 4 hours), and acyclovir 200 mg (2 capsules (400 mg) by mouth every 6 hours). The patient was instructed to call for an appointment with her primary care physician on 05-Jan-2004. The patient was discharged on 04-Jan-2004, and the outcome was reported as recovered. This report no longer meets critieria for expedited submission because it has been determined that the patient experienced expected events. Additional information has been requested.