Age: 38.0
Sex: F
Vaccine: HEP
Symptoms: Neurological examination abnormal, Pain, Petechiae, Polyneuropathy, Pyrexia
Clinical narrative: This report describes a 38 year old female who alleged that she experienced chronic inflammatory demyelinating polyneuropathy following receipt of hep b vaccine recombinant. This report was received as part of workers' compensation proceedings. The vaccinee received her first injection of Engerix-B on 10/14/1997. An unspecified time post immunization, she experienced an injection site reaction characterized by swelling and soreness. The injection site reaction resolved after an unspecified period of time. The vaccinee received her second injection of Engerix-B on 12/02/1997. She alleged that she developed chronic inflammatory demyelinating polyneuropathy on 12/03/1997, and was permanently disabled. The following info was obtained from medical records. The vaccinee underwent an independent medical examination on 12/01/1999. The physician reviewed medical records from the vaccinee's primary physicians, two endoorionologists, two rheumatologists, two urologists, one orthopedist, and a physician of unknown specialty, who associates himself with a practice entitled "Center for Immune." At the time of the examination, the vaccinee reported that some 12-18 hrs after the second injection she awakened at about 4am, screaming in pain. She had apparently gone to bed feeling well the night before. When she awakened, she did not have any fever but she describes pain in her back and abdomen in what sounds like her left flank area. She also had some pain in her right knee. She thought she was possibly suffering from a kidney stone, as she has had multiple kidney stones in the past and had undergone multiple urological procedures for nephrolithiasis. Therrefore, early that day, she contacted her personal urologist. Apparently, he evaluated her that day and performed an intravenous pyelogram which she states was noted to be negative. She indicates that the urologist told her that she did not have a kidney stone as the cause of her back, flank, and abdominal pain. He apparently thought; however, that she did have some urinary tract infectious process, ostensibly on the basis of someleukocyturia and he treated her with nitrofurantoin for this problem. The following day, on 12/04/1997, she indicates that she began to experience fever to 102, as well as flu-like symptoms with generalized aching and nausea. Diagnostic  evaluation was negative and the following day she experienced high fever with temp to 104 deg. F. This was also associated with vomiting. She also indicates that she noticed a petechial rash on her chest and upper extremities in early December 1997. However, there were no petechias noted on her lower extremities. She also states that she noticed that she had developed a wheezing, deep cough and although she had been diagnosed with asthma at the age of 21, she stated tha ther asthma was always seasonal and that she have not had any problems with her asthma for many years. She indicates that her symptomatology became progressively worse over the subsequent 7-10 days. She states that she noticed pain and swelling in her joints diffusely throughout the body including her ankles, knees, and all of the joints in her hands and fingers. She states that the symptoms progresed to the point that she couldn't move her legs at al. She also complains of severe back, neck and head pain at this time. She relates that the temp of 104 lasted only a short period of time, less than 24 hrs, and that when her fever broke, she felt quiet weak and that from that point on she began walking with a cane. She also relates that in the mid to later part of December 1997, she noticed that she was sleeping an inordinate amount of time. She and her husband commented that she had experienced difficulty with her gait and some falling episodes in December 1997. Extensive diagnostic evaluation through December 1997 was unremarkable with the exception of an elevated concentration of thyroid stimulating hormone. In the early January of 1998, the vaccinee experienced left renal colic and on 01/12/1998 was seen once again by her urologist. he diagnosed a left ureteral stone in the distal left ureter. On 01/20/1998, she was seen once again by her physician in his office. In his office record, he notes that she had continued to suffer from generalized myalgias and arthralgias. He also indicated that she had informed him that she was experiencing intermittent low-grade fevers. The vaccinee was seen by an endocrinologist on 02/02/1998, at which time she complained of more recent symptom complex which was characterized by fever, arthralgias, weakness, malaise, and difficulty embulating. Diagnostic evaluations continued to be unremarkable. The vaccinee was first evaluated by this physician of 07/12/1998. This physician stated in his office record that "nerve conduction studies showed abnormalities indicating neurological damage." The physician apparently concluded that the vaccinee's myraid of different health problems were "a result of her hep b vaccine of 12/02/1997." The vaccinee was seen by a neurologist on 01/27/2000. The findings on this neurological examination do not in any way support the diagnosis of chronic inflammatory demyelinating polyneuropathy. The vaccinee underwnet EMG and nerve conduction velocity studies of both legs on 02/10/2000. The neurologist's impression was "This is a normal bilateral lower extremity EMG and nerve conduction velocity study. There was no evidence of generalized peripheral polyneuropathy, no evidence of chronic inflammatory demeylinating peripheral polyneuropathy, no evidence of anterior horned cell disease."