Age: 40.0
Sex: M
Vaccine: ANTH
Symptoms: Exercise electrocardiogram, Exercise test normal, Fatigue, Fibrin D dimer normal, Flushing
Clinical narrative: He received anthrax #5 on 4 Jul '10. He was in good health at the time and received no other vaccines simultaneously. He had experienced no adverse events from previous anthrax or any other vaccinations. Five days later while he was lifting weights he developed a sudden severe headache with dizziness, "bright red cheeks, neck, and forehead with paleness around eye sockets." In the course of 1 to 1.5 hours, the headache continued to increase and he felt more disoriented. He reported to where the provider suspected a possible aneurysm and requested a MEDEVAC. The headache worsened ("worst in his life") and he developed photophobia and vomiting. He was MEDEVAC'd, received a CT of the head (normal) and was kept overnight for observation. The headache and vomiting continued whenever he was asked to stand or walk. He was released after 24 hours with no definitive findings and returned to duty. The next day he developed bilateral tinnitus and head congestion. (Patient defines 'head congestion' as if he "had a head cold / feeling of fullness without the symptoms of a stuffy or running nose, no other associated symptoms of a normal cold or flu.") He also developed, 7-10 days after the vaccine, a "pressure" along the spine up to the neck/lower skull, then moved down for the coccyx, with no precipitating injury, that prevented him from leaning over. This migrating spinal pressure/pain last for 2-3 months. He also developed fevers, sweats, chills and tremors about this time and that lasted 1-2 months per patient report. He also experienced episodes of palpitations, sneezing and tingling in the arms. He was then MEDEVAC'd, GE at where he underwent a full workup including, neurology, internal medicine, GI, ENT, and Audiology with no abnormal findings. After one month symptoms started to improve and he refused MEDEVAC as no condition was discovered. He and requested to be sent back and be under flight surgeon's care. CBC, CPM, TSH, B12, Lyme, hepatic panel, C-RP, d-dimer, cardiac panal, UA, and EKGs were all within normal limits. ESR was slightly elevated at 18. Symptoms began to resolve except the tinnitus. But he never felt 100% after the 5th vaccine. When he attempted to get back to wt training he felt the pain in his back and head starting to return. Tinnitus /head congestion continued. The intensity started decreasing after 1 to 2 months, but never entirely resolved. Sporadic racing heart, trembling hands, fatigue, and sneezing never resolved, but become more manageable over time. On 12 Jan 2011 he received anthrax vaccine #6. He experienced an almost identical reaction as in July '10 and weight lifting was not a available. Within 1 day the tinnitus increased from a 3/10 to a 6/10. Six to 7 days later headaches, body aches, fatigue, racing heart rate, chills, and arm paresthesias began. He described the headache as pressure throughout his entire head rated at a 3/10, increasing to a 4 or 5/10 with exertion or with Valsalva maneuver. Within days he also developed an intermittent elevated heart rate to 122, fatigue, malaise, fever/chills, difficulty concentrating, intermittent facial twitching, memory loss, back pain. With this reaction he also developed persistent rash on the face with the appearance of acne, frequent sneezing and intermittent left arm tingling. He sought evaluation and an EKG was normal, but due to his history he was again MEDEVAC'd. From there he was transferred where he continued to receive evaluation for an additional month. He was evaluated by ENT, rheumatology, neurology, and audiology. Again there were no definitive findings and the fever, chills, and twitching began to lessen by Mar 2011, but the systemic symptoms of fatigue, cognitive dysfunction, facial rash, flushing, frequent sneezing and increased resting heart rate continued. Diagnosis = Mast cell activation syndrome after full diagnostic workup.