Age: 6.0
Sex: M
Vaccine: MMR
Symptoms: Blindness, CSF test abnormal, Eye pain, Laboratory test abnormal, Malaise
Clinical narrative: It was reported in a published article, concerning a 6 year old male with no allergies, an unremarkable medical and surgical history with no family history of multiple sclerosis, Leber's optic neuritis, or other ocular or central nervous system disease who on 09/24/1975 during a routine physical examination was vaccinated with a dose of MMRII (manufacturer unknown). There was no concomitant medication. 11 days after vaccination on 10/04/75, the child developed an oral temperature of 39.4 degrees C, which lasted for one day. The child was otherwise well until 10/12/75, when he developed general malaise, left orbital pain on horizontal gaze and inability to see with his left eye.  It was noted that he was examined on 10/13/75, for bilateral optic disc swelling and decreased visual acuity. It was also noted that the pt had developed bilateral simultaneous optic neuritis 18 days after vaccination. A physical examination on admission was unremarkable except for ocular findings. Visual acuity was OD: 6/7.5 (20/25); OS: finger counting at one foot. The left pupil had an afferent defect. The right optic disc was elevated and spontaneous venous pulsations were present. In the left fundus there were elevation of the optic disc, congestion of the nerve fiber layer, scattered splinter hemorrhages and no spontaneous venous pulsations. Quantitative visual field testing was normal on the right and not obtainable on the left eye because of poor fixation. Extra ocular muscle function, anterior segment, the vitreous, macula, and the peripheral retina were all normal for each eye. Studies included computed axial tomography of the brain, which was normal.  A routine skull x-ray film series, coned down views of the sella, orbital apices, sinuses and optic foramina were also normal.  The diagnosis of bilateral optic neuritis complicating the vaccination made. Complete blood cell count, serum chemistry, serum protein electrophoresis, fluorescent treponemal antibody tests, viral serology and urology were normal.  Cerebral spinal fluid analysis revealed a glucose of 88mg/100ml; protein, 11.6mg/100ml; and chlorise 119mg/100m. The spinal tap was traumatic with many red blood cells present. No inflammatory cells were reported and cultures of this fluid were negative for pathogens.  The pt was given 40mg of prednisone orally each day. Five days later the visual acuity improved to OD: 6/6 (20/20) on the tenth day. Spontaneous venous pulsations were present bilaterally at that time. After 10 days the dosage of oral prednisone was gradually reduced during the ensuing several weeks. The visual acuity returned to 6/6 (20/20) in each eye within several weeks, but the afferent conduction defect persisted on the left. Visual fields remained normal on the right, but showed a persistent irregular inferior defect on the left. The pt's condition has remained stable for 14 months. The authors noted an additional pt with adverse events after vaccination with MMRII (manufacturer unknown)(WAES# 0409USA01386).  No further information is available. A copy of the published article is attached as further documentation of the pt's experience. Upon further review of the literature article (WAES # 0409USA01386), it was noted in the reference that the above mentioned pt (WAES # 0409USA01416) experienced adverse events after vaccination with MMRII (manufacturer unknown). WAES # 0409USA01416 was created with a date learned of 12/08/78. Follow up 03/03/05: Patient's recovery status is unknown.