Age: 14.0
Sex: M
Vaccine: TD
Symptoms: Erythema, Fatigue, Flushing, Gait disturbance, Guillain-Barre syndrome
Clinical narrative: This healthy 15 year-old received a routine tetanus-diphtheria booster on 10 July 2003. Returning from a family camping trip approximately 16-20 July 2003 he complained of fatigue with bilateral leg cramping. He initially believed this due to the drive home; however later that evening his fatigue increased with nausea, vomiting and diarrhea.  His parent's state they stayed in a resort trailer, rode horses, swam and canoed at the lake. He denied any tick or mosquito bites or any illness one month prior to this illness. He awoke the next day voicing difficulty walking.  He states he needed to "lock his knees" to keep from falling over and was unable to stand up straight.  This condition worsened over the next two days where upon his parents sought medical treatment on 23 July 2003.  The emergency room physician documented complaints of lethargy, vomiting x 1, decreased oral intake with a bad taste in the mouth, left ear pain and dizziness and not feeling well. His physical exam revealed dull left tympanic membrane and throat exudates with mild erythema, neuro grossly normal except unable to elicit reflexes on both knees with motor 5/5 and sensory intact bilaterally.  His gait was questioned as dragging on left versus crossing leg. He was treated with IV NS, oral Amoxicillin 500mg TID x 10 days for a diagnosis of left otitis media, pharyngitis and dehydration.  While attending a ball game that evening his parents described him as "looking like a child with cerebral palsy" due to the stiff jerking movements and weakness of his arms and legs. By 8-9 pm he returned to the emergency room with difficulty breathing despite 100% room air oxygen saturation, decreased appetite, flushed skin with hypersensitivity without evidence of a fever.  Full diagnostic included a spinal tap, re-examination for ticks and laboratory evaluation revealed a diagnosis of Guillain Barré Syndrome. A neurology consult was obtained (see 23 Jul 2003 consult below) and he was admitted for two weeks. During his admission he reports having 1/3rd lung capacity with complete loss of function both legs with decreased deep tendon reflexes and gross weakness with decreased use of his arms and hands. He states he developed hypertension with bradycardia that frequently triggered the monitor alarms (Blood pressure ranged 152/90-112/53 with heart rate 66-92).  IVIG factor was given on day 8-9 of admission following "confirmation" of Guillain Barré Syndrome.  Two days following IVIG factor administration he reports increased use of large muscles groups with returning use of fine motor function.  He reports muscular loss of function occurred in ascending order from his feet to head with return of muscular function in a descending order head to feet. Over the next 30 days, he reports increasing muscular function progressing from a wheel chair to walker to cane to walking normally.  He reported a weight loss of 20 pounds while hospitalized which has resolved (111-140 Lbs).  He described a reoccurrence of leg weakness with a familiar hunched position two weeks ago (Jan 2005) with marked fatigue.  He was diagnosed with mononucleosis.  These symptoms resolved two days later. He reports he has resume normal activities such as playing the guitar, marching band, sports (skiing) and schooling; yet his energy levels are not back to normal.  His also complains of a persistent hypersensitivity to both feet and the top of his head. He was referred to the Vaccine Healthcare Center on 28 March 2005 for assistance in vaccine exemption and a VAERS filing.