Age: 14.0
Sex: M
Vaccine: DTAP, FLU3, MNQ
Symptoms: Muscular weakness, Musculoskeletal stiffness, Myelitis transverse, Neck pain, Nuclear magnetic resonance imaging normal
Clinical narrative: Symptoms begun on Sunday, September 30th.  At that time patient had a c/o headache and eye socket pain.  By Wednesday, October 3rd, patient had also started experiencing body aches and neck pain.  On Thursday, patient had neck stiffness, headache, and body aches.  He went to ER at MC and spinal tap was performed.  Results were suspicious for viral meningitis and he was admitted to pediatric unit at MC under the care of Dr.  He was started on IV Rocephin and given Toradol in ER.  He was continued on Recephin in the peds unit and was given Lortab and Motrin for pain.  Patient then started developing urinary retention on Friday but was able to void twice that day with difficulty.   He also begun developing weakness, spasms and tremors in his legs and he fell from loss of balance and his knees "locking".  Friday night he was in a great deal of discomfort due to inability to void. In/out cath was done at 5 am and 500 ml of urine was emptied at that time from patient's bladder. Neurologist was consulted on Friday, and he was suspecting transverse myelitis.  Urology was consulted, and he ordered witholding of the Lortab.  Urinary retention continued and Foley cath was placed on Saturday evening.  Symptoms progressed to include numbness/tingling/crawling sensation to legs and then torso.  Pain was experienced with gown touching his skin.  Patient also complained of "spine" pain.  CT of sinuses was done and unremarkable.  He was also started on Acyclovir IV. MRI was ordered Saturday, done Sunday and showed no spinal cord compression.  Patient was transferred to another facility on Sunday night and at this time his symptoms of wakness, pain, and paresthesias was the worst.  He has been severly uncomfortable with the Foley cath due to "spasms" athe the insertion site.  He was not able to stand on his own at this time or lift his legs off the bed, he was not able to turn on his own.  He has not been able to sleep resfully any of the nights since first hospitalized. Then, Monday morning, the weakness has improved significantly and he was able to stand, lift his legs off the bed, and walk a few steps with max. assist.  The Foley cath was removed by noon due to his severe discomfort.  He was seen by neurology, Dr. and started on IV Solumedrol.  He continued to improve and was able to void with difficulty later that afternoon.  Patient continued to improve, his bladder functioning better but not quite well.  His bowels have also moved.  Slowly, the numbness /tingling/pain begun to improve as well.  On Monday he was also seen by PT and fitted with a walker, he was able to ambulate in a hallway with minimal problems with balance.  The MRI of brain and entire spine was ordered to be done on Wednesday but not done till Thursday morning.  In the meantime, Patient was also switched to oral Prednisone while the IV Solumedrol was discontinued.  MRI showed changes consistent with ADEM, per neurologist.  Patient was then discharged to home on Thursday afternoon with tapering doses of Prednisone.  His urinary problems have resolved, he was also able to walk unassited.  As of today, he is still weak in his legs, experiences itching on his torso, and has difficulties sleeping.  He is to F/u with the neurologist on November 13,2007. 10/18/07-vac rec received; Menactra U2339AA right arm, Tdap left arm (adacel)c2644aa and Fluzone U2446AA left arm.  10/30/07-records received for DOS 10/7-10/11/07-DC DX: tranverse myelitis. urinary retention resolved. Symptoms on Sunday with eye pain on Wednesday headache, stiff neck on Thursdy, temp 99.2 seen in ER Urinary retention. Saturday while in hospital developed weakness, decreased sensation with intermittent pain in lower extremities. difficulty walking on Sunday. PE: sensory deficit in lower extremity with no muscle weakness.   Nauea and dizziness. Treated with high dose steroids. At time of discharge complaint of tingling sensation in abdomen. Lower extremity weakness improved.  Per 60 day follow up: He does not have any residual symptoms at this time, but F/U MRI in December showed persistent demyelination with no new lesions and minimal improvement from prior study. He has finished 12-week PREDNISONE therapy and suffered many side-effects from this, some of these improved while others still continue. Annual Follow-up Information 08-DEC-2008: F/U scheduled for abnormal eye examinations.