Age: 16.0
Sex: F
Vaccine: HPV4, HPV4, HPV4
Symptoms: Lumbar puncture normal, Malaise, Memory impairment, Meningeal disorder, Metabolic function test
Clinical narrative: 7/3 Aprox 4:30pm 16 yr old girl (PT) received Gardasil injection (only vaccine given) from PCM during well visit. Patient was in good health. Aprox 5:05pm PT started to behave strangely, was experiencing "very vivid imagery" said "this drug is funny" began hysterically laughing, then shortly thereafter began hysterically crying. Aprox 5:15pm PT was exhibiting erratic behavior and inability to regulate emotions, stated she "couldn't feel her legs, they were heavy and hard to move" and felt like "If she didn't remind herself to breath she would forget." Mom returned to PCM, during car ride PT's respiration was decreasing and becoming light, PT would gasp for air. Upon arrival to PCM at aprox 5:25pm PT stated "throat felt tight and it was hard to breath and feeling like she was suffocating" PT's breathing was diminished and heart rate was increasing PCM directed mother to take PT ER. 5:35pm Upon arrival and check in at ER PT was "wobbly" and having difficulty maintaining balance. During admittance PT was hysterically crying and disoriented. PT was having difficulty with gross motor functions (could not button shirt or walk to bathroom with out assistance.) PT was admitted and became increasingly erratic in behavior, hypersensitive to touch, and movement. PT Experienced 3 tachycardic events and had heart rates as high as 180+, BP rose several time to rate as high as 179/112. ER administered IV push Benadryl and 1 mg Ativan. PT blood work, tox screen and urine came back unremarkable and free of drugs. PT was treated for an anaphylactic reaction, cleared by psych eval and released. 7/4 PT woke lethargic. Was disoriented and exhibiting erratic behavior inability to regulate mood throughout the day.  At approximately 5pm PT reported blurred vision, pain in hand, tightening of throat, and heavy legs. PT was unable to remain in social situations and removed herself from others, began crying. PT reported feelings of paranoia. 7/5 PT woke complaining of severe headache, at base of neck, with pain radiating down spine aprox 3 inches. PT complained of ears feeling stuffy and eyes hurting, and stomach pain.  PT still exhibited inability to regulate mood. PT stated her vision was "weird" and would see blurs of colors. PT saw PCM at aprox 12:45. During course of exam PCM witness 3 distinct mood changes. PCM witness hypersensitivity to touch. For the remained of the day PT appear dissociative, and distant. PT could not remember events throughout the day. 7/6 PT Was tired and lethargic most of the day. PT verbalized that she felt incredibly depressed but didn't know why. PT stated that she didn't want to be around people outside of the home because she was unsure of how her emotions would come out, and couldn't control, from one moment to the next if she would cry or not.  PT still experienced numbness/heaviness in legs, blurred vision and pain behind the knees and elbows. 7/7 PT "Still did not feel herself and had overwhelming feeling of depression." When asked what she would like to do or what she wanted to eat PT responded "I don't know" "I don't care" When mother asked how she was feeling and what symptoms she was experiencing PT said I don't remember what I felt like or was doing the other days. PT sated that her vision felt fuzzy and off, "like she was wearing the wrong prescription of glasses and her eyes were trying to adjust." PT continued to display erratic and atypical behavior. 7/8 PT informed PCM that she still had a headache and just didn't feel herself but did not know how to explain it. When asked to compare her symptoms/mood/feeling to previous week, PT did not remember what behaviors she exhibited during DAY 2, 3, 4 post vaccination. PT legs feel heavy, experienced pressure in her ears and stated eyes feel heavy. Companied of an overall general feeling of "being sick, tingling in inner ear and sometime trails of light/colors hues when she looks at things. 7/9 PT felt depressed. Hard to focus vision. Heaviness in neck and eyes. Mood fluctuation. Tried to write a grocery list and couldn't. PT had memory difficulties and was unable to recall events from earlier in the day and days prior. PT experienced hallucination. 7/10 PT lethargic, hypersensitive to touch, smell and sound. PT was disoriented and confused, had a hard time forming sentences, and difficulty pronouncing some words. PT experienced blurred vision, heavy legs, and had 1 episode of a panic attack. 7/11 PT evaluated by neurologist, and presented with neurological processing deficits and memory issues. Was admitted to hospital for full neurological work up. 7/12 Patient complained of severe headache, numbness in legs, blurred vision, had memory issues and processing deficits. Could not state correct date, month, year, and unable to complete tasks that crossed hemisphere, recall verbal lists or accurately copy some pictures, solve simple math problems. (PT had no prior history of processing issues or neurological deficits, and historically has scored proficient or advanced on state academic exams). 7/13 PT diagnoses with encephalitis. MRI showed diffused meningeal enhancement. Spinal Tap/ Lumbar puncture was unremarkable and negative for bacterial meningitis. EEG/EMU was negative for seizures. There is no know cause for PT condition and symptoms other than the HPV vaccine. 7/14 PT still shows processing issues and memory loss as well as short term memory issues. PT states the ground feel spongy when she walks. Neurologist has ordered full psycho education work up and ambulatory EMU.