Age: 42.0
Sex: M
Vaccine: ANTH
Symptoms: Feeling hot, Flushing, Hyperhidrosis, Laboratory test abnormal, Lethargy
Clinical narrative: Developed right eye and right arm myopathy four months after Anthrax #3.  Service member is now due for Anthrax #4, but he has concerns regarding his present medical condition and history of myopathy and questionable seizure activity.   IMMUNIZATION          DATE                                  SYMPTOMS Anthrax #1 20 March 03 No problems noted. Anthrax #2 03 April 03 After receiving this vaccination, he began to feel hot, clammy, and dizzy when he stood up.  This resolved within a few minutes.  He continued to feel weak for the rest of the day but no complaints after that day.  Denies any motor weakness, numbness, or tingling. Anthrax #3 17 April 03 No problems noted.  13 Aug 03 In the middle of the night, he awoke and felt "hot and sweaty."  He got out of bed, went into the kitchen to get something to drink.  His wife reports that he was flushed and looked "strawberry red all over."  She returned to bed but then heard a crash in the kitchen where she found him leaning over the table unaware of what had happened or what was going on.  She immediately dialed 911.  While waiting for the paramedics to arrive, his daughter witnessed his upper body uncontrollably shaking for 4-5 minutes.  He then was confused and lethargic.  No loss of bowel or bladder control.  He had difficulty ambulating.He was evaluated by a neurologist Dr. and diagnosed with myopathy-possibly related to recent statin use.  Due to hyperlipidemia, he had recently had several changes in his medications. (Initially, he was on Lescol, which was then changed to Lipitor.  Lipitor was later stopped and Niacin was started. Then Niacin was stopped, and Zocor was started.  After his triglycerides increased further, Tricor was started.  Then both were stopped, and Niacin was restarted.  He stopped the Niacin near the end of July. ) He had had no complaints of muscle pain or weakness prior to this time.  No prior history of seizure disorder.  Diagnostic testing revealed Normal Head CT, MRI-brain, and EEG.  An EMG was then ordered which showed weakness in his right arm and right eye.  He was then referred to an ophthalmologist, Dr. for evaluation.He was told that the myopathy was related to his recent statin use.  All lipid-lowering medications were stopped.  He was placed on a low cholesterol diet and exercise program.  He also has a referral to see a cardiologist for evaluation since he can no longer be on lipid-lowering medications.  He was not started on any seizure medication.Since his diagnosis, the service member has not experienced any further seizure-like activities.  He reports feeling "more tired than usual" and has noted some weakness in his right arm.  He occasionally experiences "double vision" if he looks to the right, but he has learned to avoid this by turning his head to look to the right.  15 October 03 The service member is now due for Anthrax #4.  He questioned his civilian neurologist whether continuation of the Anthrax vaccine could worsen his myopathy.  His civilian neurologist reportedly declined to give him clearance for the vaccine until he has further information regarding anthrax vaccination.  The service member would like to continue the anthrax series if it is determined it is safe for him to do so.Since his diagnosis, the service member has not experienced any further seizure-like activities.  He reports feeling "more tired than usual" and has noted some weakness in his right arm.  He occasionally experiences "double vision" if he looks to the right, but he has learned to avoid this by turning his head to look to the right.