Age: 19.0
Sex: F
Vaccine: HPV4, HPV4, HPV4, HPV4, HPV4
Symptoms: Pain, Parvovirus B19 serology, Pharyngolaryngeal pain, Pyrexia, Red blood cell count decreased
Clinical narrative: My daughter is currently in hospital on steroids.  After receiving the vaccine Gardasil around March 14th - she began having a FOU for over 30 days.  Her white & red blood count have dropped (8.0) and her immunity is active.  Unknown cause.  5/16/08 Reviewed hospital medical records for 4/24-5/1/2008. FINAL DX: fever & leukopenia; autoimmune hemolytic anemia. Records reveal patient experienced fever for more than 30 days w/nausea,  intermittent vomiting, malaise, poor appetite, weight loss, stomach discomfort, weakness, fatigue, HA, shotty cervical lymphadenopathy, muscle aches/pains, leukopenia, anemia & hepatitis.  Exam revealed mild spenic enlargment & intermittent heart murmur. Heme & Rheum consults done.  Tx w/steroids & d/c to home on continued steroids w/f/u.  5/23/08 Reviewed PCP medical records which included vax records, student health records, consultant records, hospital records & labs.  Non-duplicated hospital records will be scaned.  Records reveal patient was fatigued after vaccination on 3/14.  Developed fever, chills, sore throat, body aches, decreased energy & seen by PCP on 3/21. Pts college roomate currently had mono.  Dx w/viral syndrome.  Began to feel very weak, had difficulty walking & soon became unable to complete college classes.  Seen in student health center 3/31 w/fever, chills, sore throat, body aches, fatigue, nausea & mono-like symptoms.  Dx w/viral syndrome & anemia. Health continued to decline w/vomiting, loss of appetite, weight loss, pain in low back & abdomen.  Internal med consult 4/11/08.  ID consult of 4/15/08 Admitted to hospital 4/24.  Follow-up Information 22-MAY-2008: Pt was a freshman at university when she became ill in March 2008. She had received the second Gardasil Vaccine at doctor on March 14th, 2008. She felt fatigued after the vaccine and went to bed early that day. Since then, she has lost 25 lbs, and currently her WBC is (2.3) Lymp (14), Neut (1.9) HGB (9.6) platelet count (159) has developed hemolytic anemia. She was admitted and hospitalzied for FUO (fevers as high as 104) at hospital for 7 days and released on May 1, 2008. She tested positive for coombs, double-strand DNA and very high ANA in the 2500's. She has been diagnosed by several Drs-all listed on next page: internists, infectious disease, hematologist and rhuematologist at the hospital. We are still unsure what is wrong with her. History: Patient became fatigued after receiving the vaccine. Her health began to decline and she followed up with a Pediatrician visit a week later. Mono tests were negative, diagnosis was viral. Patient returned to college and continued to feel weak and ill. Soon she developed lower leg weakness, vomitting, and fever. She started feeling very tired during activity and soon had difficulty walking to class and doing everyday activities. She began sleeping excessively, and feeling fluish. Dr examined her at the health clinic at university on 3-31 for fever, chills sore throat, body aches, fatigue, nausea and mono like symptoms. Her labwork indicated a viral syndrome and anemia. She had a low white and red blood count, vomiting, no appetite, enflamed liver and spleen, dark urine, shortness of breath. She lost her appetite and her condition continued to decline. She had FUO for 37 days and she began vomiting when she attempted to eat. She had severe discomfort and pain in her lower back and abdomen area. Her mother drove to school and checked her into a hotel so she could try to finish the semester and take care of her. They went to doctor for internal medicine. After no diagnosis and much lab work, doctor referred her to his colleague in Infectious disease. Doctor tested her for several disease and after 10 days of uncomfirmed diagnosis, recommended that patient be put into a hospital for FUO and low white and red blood counts. Her SGOT was 388. Doctor also found a small heart murmur. Family drove back home and went to Cardiology doctor. He found her heart in good condition. Doctor referred her to another Infectious Disease doctor. Doctor checked her into hospital for FUO on APril 24th until May 1st. Patient's fever continued to rise to 104 daily and doctor referred her to Hematologist. Doctor ordered bone marrow and more blood tests, CT scans, x-rays and more labwork. Patient's hemoglobin went to 7.9 andwhite blood count as low as 1.7. Patient's liver and spleen were enlarged and her urine became amber-dark brown in color. There were abnormalities seen in upper abdomen and within the mesentery of small bowel. Lymph notes were also seen within the mesentery of the upper pelvis as well as along th right external iliac node chain and left external iliac node chain. No evidence of ascites. Her condition appeared to be viral but no final diagnosis has been reached. She soon developed Auto-immune Hemolytic Anemia and a transfusion was recommended, but not done. Rheumatologist was called into the case at the hospital by the hematologist and he tested her for autoimmune deficiencies. Her ANA test, Coombs test and double strand DNA were positive. In addition to the Doctors mentioned in this letter, the family consulted Pediatric Hematology doctor who also examined patient in the hospital. Doctor felt that her active immune system from a mono-like virus reacted to the Gardasil vaccine, which caused her to developed hemolytic anemia. He recommended trying to avoid a transfusion, putting her on prednisone and retesting patient after she was off the steroids. Doctor prescribed 60 MG of prednisone and her fever became normal. Doctors felt that patient may have developed lupus. Patient was sent home from the hospital after her fever returned to normal when she was put on 60 mg of Prednisone. She is currently on 20 mg of prednisone daily and her hemoglobin has stabilized to 9.6. She is at home at rest. Currently, she has tested positive for Epstein barr-IGg, CMV virus (also IGm) Parvovirus (IGg), Toxoplasma (positive IGg and IGm) and West Nile Virus (IGm) and IGm-equivocal-needs to be retested. Patient's parents consulted the services of the CDC who recommended they send in a VAERS report. They submitted one on APril 27, considering the possibility that her illness is an adverse reaction to the Gardasil Vaccine administered 3-14-08. A nurse from the Vaccine Adverse Event Reporting system confirmed receiving the report on 5-8-08 and agreed to look into the hospital records as well as the lot number of the Gardasil vaccine from doctor's office. At this time, patient's fever has returned as she is tapering off the prrednisone. She has lost 25 pounds and her fever has returned (as high as 103.5), she has lower back and some joint pain. It is difficult for her to do everyday activities, and she had to withdrawal from college classes with one week to finish. She has taken incomplete and plans to finish her work when she has the strength to do so. We are hopeful that patient's health will improve, but at this time we are still unsure of a final diagnosis. Patient has an appointment with Rheumatology doctor tomorrow 5-23/08. Follow-up: My daughter continues to have problems from vaccine and active immune system. She was in hospital with hemolytic anemia. She was in hospital for 26 days where she was diagnosed with Lupus, or Lupus-like disease. Patient has had 2 seizures and was back in hospital for 4 days for an allergic reaction to medicine (DILANTIN they think.) She still is fighting with low white and red blood cells, is on medicines for seizures and is getting over psychosis from the medicine or maybe lupus cerebritis. She will not be returning in the fall. This has been a horrible 4 months.