Age: 47.0
Sex: M
Vaccine: FLU3
Symptoms: Blood product transfusion, Guillain-Barre syndrome, Lumbar puncture, Plasmapheresis
Clinical narrative: Guillain-Barre Syndrome, plasma exchange and intravenous immunoglobin.  1/12/09 Reviewed hospital D/C summary for 11/8-12/18/2008. FINAL DX: quadriplegia secondary to GBS, may be assoc w/flu vaccine; respiratory failure s/p intubation & tracheostomy; dysphagia s/p PEG tube placement; severe functional decline secondary to GBS; vegetative s/p GBS; constipation secondary to narcotic use; altered level of sensorium secondary to GBS.  1/9/08 Reviewed hospital medical records of 11/08-12/18/2008.  Neuro consult states post-vaccination acute demyelinating polyradiculopathy.  Quadriparesis secondary to GBS.  Records reveal patient experienced bilateral leg weakness, ?GBS, severe multi-joint pain, increased LFTs & r/o autoimmune disease. Had flu symptoms after flu shot, improved, then symptoms recurred withapprox 4-5 days prior to admit with weakness, fatigue, fever, decreased appetite, weight loss, tingling in extremities, dificulty standing/walking.  Had flu shots every year w/o problems.  Seen by PCP after ER visit on 11/8 as he continued to worsen & then direct admitted.  Neuro consult done & initially WNL.   GI consult done & dx w/acute viral hepatitis syndrome.     Rheum consult done & dx w/polyarticular arthralgia.  ID consult done & dx w/viral syndrome.  Cardio consult done & w/w. abnormal EKG, viral syndrome r/o cardiomyopathy.  Tx w/steroids & initially improved.  Became areflexic & LP done. Dx w/GBS.  Tx w/IVIG x 7 days.  Developed respiratory distress, intubated, ICU.  Tx w/plasmapheresis x 5 days.  Failed vent weaning & was trached & had PEG feeding tube on 12/3. Progressed slowly & d/c to inpatient rehab hospital.  8/25/09 Received hospital d/c summary of 5/4-5/8/09. FINAL DX: quadriplegia secondary to GBS, improving.  Now UE motor function 4/5, LE motor function 2/5; hx of GBS 10/08; painful dysesthesias of all extremities; narcotic dependence; hx of HTN. Records reveal patient had been tx w/high dose narcotics for pai management while in acute care & when transferred to SNF, meds were not available immediately.  Pt developed excruciating pain & full blown narcotic withdrawal & had to be admitted to acute care hosp for pain management & withdrawal control.  While there, PICC line d/c & transitioned to oral meds by pain mgt  & neuro consult.  Transferred to inpatient rehab facility to continue therapy, bowel regimen, & pain med wean.  1/9/08 Reviewed ER records of 11/6/2008. FINAL DX: chest wall pain & viral syndrome Records reveal patient experienced chest & abdominal pain, weakness, dizzy & flu symptoms of HA cough fever & chills, right shoulder pain, numbness & tingling of hands & feet x 2 days.  Improved & d/c to home. 9/28/09 D/C summary received for date of service 12/30/08 to 5/3/09.  Admit and D/C DX: GBS, facial dermatitis, UTI, Urinary retention.  8/25/09 Received hospital d/c summary of 5/4-5/8/09. FINAL DX: quadriplegia secondary to GBS, improving.  Now UE motor function 4/5, LE motor function 2/5; hx of GBS 10/08; painful dysesthesias of all extremities; narcotic dependence; hx of HTN. Records reveal patient had been tx w/high dose narcotics for pain management while in acute care & when transferred to SNF, meds were not available immediately.  Pt developed excruciating pain & full blown narcotic withdrawal & had to be admitted to acute care hosp for pain management & withdrawal control.  While there, PICC line d/c & transitioned to oral meds by pain mgt  & neuro consult.  Transferred to inpatient rehab facility to continue therapy, bowel regimen, & pain med wean./ss  9/28/09 D/C summary received for date of service 12/30/08 to 5/3/09.  Admit and D/C DX: GBS, facial dermatitis, UTI, Urinary retention,  PMH: GERD, Depression, Respitory failure, Dysphagia, Clostridium difficile.    bhp  9/28/09 Received hospital D/C summary for 12/19-12/24/2008. FINAL DX: supraventricular tachycardia & fever Had been transferred to rehab w/trach & PEG & continued pain management issues.  While in rehab developed tachycardia 170-180 & fever 100.8.  Transferred fo acute care for management.  Progressed well & d/c back to inpatient rehab./ss  9/28/09 Received rehab D/C summary for 12/30-5/3/2009. FINAL DX: Guillain-Barre syndrome Record reveals that patient had slow but steady improvement w/improved pain control & muscle function.  Co-morbidity included: UTI, urinary retention, HTN, GERD, depression, anxiety, c-diff colitis, respiratory failure w/weaning from vent & trach d/c, dysphagia w/weaning off PEG to regular PO diet./ss  9/28/09 Received hospital D/C summary for 12/19-12/24/2008. FINAL DX: supraventricular tachycardia & fever Had been transferred to rehab w/trach & PEG & continued pain management issues.  While in rehab developed tachycardia 170-180 & fever 100.8.  Transferred fo acute care for management.  Progressed well & d/c back to inpatient rehab./ss  9/28/09 Received rehab D/C summary for 12/30-5/3/2009. FINAL DX: Guillain-Barre syndrome Record reveals that patient had slow but steady improvement w/improved pain control & muscle function.  Co-morbidity included: UTI, urinary retention, HTN, GERD, depression, anxiety, c-diff colitis, respiratory failure w/weaning from vent & trach d/c, dysphagia w/weaning off PEG to regular PO diet./ss  10/13/09 PCP and D/C summaries services dates 5/8/09 to 6/27/09. Assessment: Guillain-Barre syndrome, resolving quadraparesis, respiratory failure and intubation, pain upper and lower extremities with dysethesias and hypersensitivities, musculoskeletal and smooth muscle spasms, deficits in self-care and mobility.  Patient was initially admitted to a hospital, tracheostomy required, gastrostomy tube placed. Sent to rehabilitation center for continued medical and subacute management, weaned off ventilater, transferred to another facility for further therapy and pain management. Can ambulate with walker, wheelchair used for long distances. Patient is being discharged home with his wife. Continued therapy provided by home health and on outpatient bases.