Age: 16.0
Sex: F
Vaccine: HPV4
Symptoms: Nightmare, Nuclear magnetic resonance imaging, Poor quality sleep, Pyrexia, Rash erythematous
Clinical narrative: Information has been received from an employee concerning a 16 year old female, who on 25-SEP-2008 was vaccinated with GARDASIL (1st dose). The patient never had any psychiatric event, athlete (she plays sand volleyball), does not use to get out at night, studding the 2nd year of high school. Anybody in the family has a history of psychiatric disease or had taken anytime drugs for this condition. Her family begins to notice that the patient was very thirsty (she drunk 31 or more daily), very high anxiety and euphoria approximately 15 days before the outbreak (09-OCT-2008). She used to write happiness notes to her mother, talk about everything with her eyes widened-she gave the impression that "there is no one so happy than me". Her family begins to be surprised, but didn't think that I was something important or severe. On 23-OCT-2008, the patient left school and come back to her home because she had a malaise. On 23 and 24-OCT-2008, she had a very severe insomnia (she slept very little time and woke up thereafter with a peculiar anxiety). Insomnia was higher at the day- break between days 24 and 25-OCT-2008. In the morning of day 25-OCT-2008, from the morning until afternoon the patient was loosing her control, very agitated and anxious- she beat in her relatives, asked for a beer, asked for a knife, she throw out to a window (that had a rail), she told that she was going to materialize with the sofa (hallucinations), much anxiety. The reporter compared the patient's behavior with the character of the movie "exorcist". Starting in the morning, during the afternoon the picture was more intense, the pictures appeared and the patient was uncontrollable. At night, the psychiatrist was called who prescribed EUTONIS, performed a sub-valuation, stating that "it was a very small crisis, with no importance". The patient took a tablet that had no effect, and the physician ordered to take a second one, which she took, but without any effect. The patient nodded (sometimes for 5-10 minutes), when she arouses she didn't distinguish if that is real or not, she took time to be aware that it wasn't a dream. The reporter said that it appeared that "the cloxazolam opened the door between conscious and unconscious, not allowing the patient to sleep because she "entered" in the dream". After this first episode, the patient had always nightmares while sleeping (always nightmares with reality things). During next days, she had no more hallucination pictures, but she has delirium pictures mainly while sleeping. The patient didn't sleep and passed 5 days without sleeping. The patient was always extrovert, but always inside the considered as normal. At the day-brake of Saturday, a psychiatrist friend of the reporter had prescribed SEOQUEL by phone, because he was travelling. In the afternoon of Sunday another psychiatrist had prescribed AMPLICTIL. And the patient took together  cloxasolam and chlorpromazine. In the night between Sunday and Monday, the physician was administering the two drugs and the patient fainted (due to weakness, dizziness and fall of pressure). Until Thursday they were with this psychiatrist, but resolved to change for another because the situation was not improving. The family thought that the patient needed to sleep. They went to a fourth psychiatrist (day 30-OCT-2008), who interrupted previous drugs and prescribed RIVOTRIL, DONAREN and ZYPREXA. In case of much agitation, HALDOL, and FENERGAN were used- to fight the side effects of the other drugs. From Thursday day 30-OCT-2008 to 10-NOV-2008- she remained receiving this treatment. The patient had a "zumbi" aspect. She was totally doped, she didn't sleep and the episodes of violence turned back. The psychiatrist said the she could want to kill herself and become very violent thus, she would require a homecare. She became very violent; she wanted to beat on persons, with a very strong anxiety again. She woke up every day at 6 am, willing to go to school. And nobody could dissuate her of this idea- she was obsessed with this and wanted at any rate. She had a loss of weight, diction weakened, stopped to eat, excessive salivation. She didn't rise from the bed, became unconscious. After about 5 days from the outbreak, (30-OCT-2008), she starts to have always fever between 37-38 C. They went to hospital, was hospitalized on day 10-NOV-2008 already being carried, her pressure was low. She is hospitalized until today. The psychiatrist's hospital stopped all drugs on Monday to detoxify and after some days (not exactly know when), he started with DEPAKOTE (not sure about this) plus prometazine. The patient was not eating well, choked a lot and this hampered the sleep as well. On Monday, day 10-NOV-2008 was the first night where the patient could sleep throughout the night, with no interruption, like a log. On Tuesday, she also sleep well, but awoke during the night. After hospitalization, red plaques was appearing and disappearing at chest neck, between the breasts, neck and face, sometimes in seconds. This had occurred 5 to 6 times. She was undertaken to image test, brain magnetic resonance imaging, three electroencephalographys- and in the third (20-NOV-2008 approximately) an alteration was confirmed- epileptic focus. The neuro pediatrician started to think in lupus asked for exam. Spinal tap found 12 white cells (one laboratory found 2 cells and other found 12 cells in liquor- 5 or more cells in liquor may indicate something). The psychiatrist asked several blood tests, between them anti-nuclear factor, which was positive, but it is inconclusive, as other positive results that had appeared. The rheumatologist asked some specific exams. And decided to start on Sunday, the pulsetherapy with corticoid to treat lupus, which the patient continues until now. No further information is available.