Age: 54.0
Sex: F
Vaccine: PPV
Symptoms: Back pain, Cellulitis, Injection site abscess, Injection site erythema, Injection site induration
Clinical narrative: Information has been received from a health professional concerning a 53 year old female with allergies to tetanus toxoid and butorphanol tartrate (Stadol) and a history of asthma who on 11/26/03 was vaccinated IM in the left gluteal muscle with a first 0.5ml dose of pneumococcal 23v polysaccharide vaccine (643823/0869N). It was noted that at the time of vaccination the pt was recovering from pneumonia. The reporter indicated that the pt developed cellulitis after vaccination. It was noted that therapy with pneumococcal 23v polysaccharide vaccine was discontinued. Unspecified medical attention was sought and a prescription drug was not required. At the time of the report, the outcome was unknown. A product quality complaint was not involved. Follow-up info was received from a woman in a physician's office which indicated that on 11/27/03 the pt developed cellulitis of the left gluteal area. On 11/28/03 the pt presented to the hospital with fever, nausea, and back pain. She was admitted the same day with ostensibly fever of unknown origin. An infectious disease consult was obtained. A bone scan was ordered. Infectious disease ordered some studies. Lab tests on admission revealed a white blood cell count of 30,100, hemoglobin 14.5, hematocrit 42.8, erythrocyte sed rate 62, blood urea nitrogen 10, creatinine 0.8, chloride 102, sodium 136, potassium 4.3, glucose 120, calcium 8.4, phosphorus 2.7, and magnesium 1.9. Liver function tests were normal, a Clostridium difficulie toxin test was negative, and influenza A and B antibodies were pending. An ultrasound of the kidneys was unremarkable and a chest x-ray was clear and showed definite resolution of an earlier pneumonia. She was started on IV fluids. Infectious disease chose vancomycin for her antibiotic. It became clear, on the second hospital day, that she was developing an abcess/cellulitis of her left gluteal area. Because of the possibility of osteomyelitis, a bone scan was done. When it showed an area that lit up on her thoracic spine, plain films were done which showed minimal compression of one of her vertebra suggesting that she needed to have a bone density scan which will be done as an outpatient. After methicillin-resistant Staphylococcus aureus screening was negative, she was changed to Ancef. She became afebrile fairly quickly, and her cellulitis began to regress rather dramatically. Her white blood cell count came down fairly quickly with antibiotic support and the day prior to discharge it was 9,800. She was discharged with minimal erythema with an area of induration that was approximately two inches in length in her left gluteal area. A surgical consult was obtained. It was felt that incision and drainage was not necessary and so she was discharged on 12/2/03 to be followed up as an outpatient. Her discharge diagnosis was cellulitis left gluteal area at the site of pneumococcal 23v polysaccharide vaccine injection, asthma, and recurring sinus infections. Discharge medications included Keflex 500mg QID for 10 days, Advair 100/50 one puff BID, Combivent inhaler two puffs QID, albuterol two puffs PRN, montelukast sodium 10mg QID, and Synthroid 0.150mg QD. She was placed on a regular diet with activity as tolerated. She was not to return to work until being seen by her physician one week after discharge. After being hospitalized for "five days," the pt was considered recovered from the cellulitis as of 12/9/03. Information was received on 12/30/03 which pertained to events that occurred two days after vaccination with pneumococcal 23v polysaccharide vaccine. This info contained the following adverse experiences: minimal compression left side of vertebral body at the level of T9 12/28/03 and recurring sinus infections (onset date unspecified). No further info is expected.