Age: 35.0
Sex: M
Vaccine: ANTH, FLUX, HEP, HEPA, IPV, MMR, SMALL, TD
Symptoms: Arthralgia, Chills, Erythema, Hypoaesthesia, Injection site mass
Clinical narrative: Ulnar neuropathy, Recurrent URI, Night Sweats, Arthralgia.  HPI:  Patient received smallpox vaccination (primary-3 jabs), Anthrax #1, Hep A #1, MMR, TD, Hep B #1, IPV, Typhoid, and Influenza vaccinations on 10/16/03.  He developed fever, chills, generalized muscle aches, and cold-like symptoms the next day.  He also reports night sweats for two weeks that have persisted.  Of note, he received Anthrax #1 in tricep area of left arm.  He does not recall any redness, knot, or pain at the site of the vaccination but he developed pain in his left elbow 2-3 days after the vaccine.  The pain was localized over the elbow but area without redness, swelling, or increased temperature.  On 11/4/03, he received Anthrax #2 in his right arm tricep area.  He recalls that he had a marble-sized knot that developed at the site of vaccination, along with some redness the same size as the knot.  He states that the knot persisted for 1-2 months.  He states that his arm was sore at the site of the vaccination but does not recall any lymphadenopathy or limitation in movement with his arm. Approximately one week after the vaccination, he developed numbness and tingling in bilateral hands while driving with both hands on the steering wheels.  The sensation started at the level of the wrists and radiated down to the tips of all fingers.  He also started experiencing the same sensation at night when he would raise his arms up with elbow flexed and hands under his pillow.  He noticed it occurred first in his left hand but later developed in his right hand as well.  The numbness and tingling would resolve in a few minutes if he changed the position of his arm and shook out his hands.  He did not seek medical evaluation at that time.He also began experiencing a burning ache in his right elbow a few days after this vaccination that was the same as the pain he had experienced in his left elbow.  He continues to experience the aching discomfort on a daily basis, most often while at rest or at night.  On 11/21/03, he received Anthrax #3 SQ in his right deltoid and Hep B #2.  He continued to experience the numbness and tingling in bilateral hands and wrists and the burning ache in bilateral elbows.    On 2/18/04, he was referred to the Healthcare Center for evaluation of above symptoms.  He continues to experience the peripheral neuropathy and arthralgia in bilateral elbows.  He took Ibuprofen almost daily in November 2003 but stopped taking it in December 2003 when the elbow arthralgia seemed to be getting better.  However, in January 2004 while on sitting on a bus for 3-4 hours, he started developing the same burning ache in bilateral knees.  Since then, he has experienced daily pain in bilateral knees and elbows.  He continues to notice the pain more with rest and at night.  He denies any difficulty with movement but states that at times after resting for long periods of time, he feels unsteady and weak.  He states, "I have to force myself through the motion, but once I get going, I feel normal."  He notices this after sitting or lying for long periods and when he first starts lifting weights.He also is concerned over recurring upper respiratory infections.  He states that since November, he "never feels totally well."  He reports frequent sneezing, rhinorrhea, and chest congestion.  He denies any past history of environmental or food allergies.  In addition, he developed an ear infection and conjunctivitis in November 2003 and again at the beginning of February 2004.  He reports occasional continued night sweats that occur for a few nights, then stop, only to return a few weeks later.  He is unsure of whether or not he has had any fever.  He sought medical evaluation for the conjunctivitis and respiratory symptoms in November 2003 and 11 Jan 04. He has used Tylenol PM, Sudafed, and Vicks OTC medication as needed.   Treatment:  Motrin 800 mg po TID, elbow splints qhs