Age: 3.0
Sex: M
Vaccine: FLU3
Symptoms: Viral infection
Clinical narrative: Patient received an Influenza vaccination (multi-dose) on 1/22/07 during a slightly belated 3 yr physical. Within the weeks that followed the vaccination, patient started shaking his hands like they hurt, wouldn't make sustained eye contact, was talking less, started doing odd rolling eye and large open mouth movements, started twirling his hair/ripping his hair out, and experienced many nighttime sleep issues (not going to sleep or awaking in the early hours.  I called the Pediatrician shortly after onset of odd behaviors (within the first week following the vaccination) and was given a referral to a neurodevelopmental pediatrician.  I returned to the pediatrician on 2/20/07 due to patient having 2 days of over 100 degree fever--which was diagnosed as viral in nature. On 2/21/07 patient was evaluated by the neurodevelopmental pediatrician and diagnosed having behaviors and function consistent with Autistic Spectrum Disorder. I then returned to the regular pediatrician due to patient's excessive and prolonged diarrhea.  Stool samples sent 3/8/07 after 11 straight days of diarrhea (including the specimen) appeared normal per microscopic exam, pH, blood, leukocyte, fat, sugar, reducing substances. Endoscopy was performed on 4/4/07 by a GI specialist: Biopsy of distal colon showed reactive lympoind nodules and eosinophil infiltration of lamina propria. Normal esophagus and duodenum. Diarrhea abated when triggers of IgG mediated food sensitivity are avoided--these food triggers diagnosed in 04/19/07. Patient is continuing to eat a restricted diet, is recieving multiple vitamin/mineral supplements, has been in an autistic classroom at the public school since 1 month after the vaccine event, is receiving additional private speech therapy, and is undergoing chelation to try to remove heavy metals that are consistent with his metabolic blockage profile (as evidenced by his build-up of porphyrin precursors consistent with heavy metal toxicity). His sleep has improved and some of the speech that he lost is returning since his absolute low point last March (2 months after the vaccination) but he is still autistic as quartely follow-ups with the neurodevelopmental pediatrician confirm.  3/11/08 Reviewed pcp medical records of 11/2003 to 12/2007 which reveal expressive speech delay first noted 12/2005. Referred for ST eval 5/2006, for early childhood intervention program 9/2006 & OT 1/2007.  Eval by neurodevelopmental pediatrician 2/2007 who observed poor eye contact, selective attention, difficulty following directions, tantrums, repetitive & perseverative play & stimming.   Referred to allergist & GI.  GI w/u revealed mild allergic type colitis.  Allergy testing reportedly demonstrated elevated IgG to many different food groups.  Tx includes: dietary restrictions & chelation. FINAL DX: Autism Spectrum Disorder. Annual Follow-up Information 19-MAR-2009: Stools have failed to normalized (become formed) for any length of time whatsoever, with runny stools, we still can't potty train. Eye contact is back but engagement is inconsistent and requires strong motivators. The language that patient lost in the 1 month period of downward spiral and onset of gastrointestinal problems following the age 3yr 2mo flu shot is coming back slowly. It is more echolalic than spontaneous and not to the ability or extent of scripting. His abilities have climbed back to where he was at age 3 prior to flu shot, but the GI distress and odd stimming behaviors that he aquired following the flu shot have not gone away.