Age: 50.0
Sex: M
Vaccine: LYME
Symptoms: Myositis, Nausea, Syncope
Clinical narrative: Following dose 2, the pt experienced joint pain. He was seen by a physician and treated with prednisone. The most recent information received on 9/9/99, reports the condition of the pt is improving. The follow up received on 8/7/00 states anterior chest wall syndrome with chest pressure, near syncope and vertigo. The vaccinee is allergic to morphine. Concurrent clinical conditions included nasal congestion. Concurrent medications included Flonase and Allegra. The vaccinee received his first injection of LYMErix on 5/14/99. Subsequently he had mild symptoms of joint pain. The second injection of LYMErix was given on 6/11/99. Following the second injection, in Mid-July 1999, he experienced more severe joint pain, muscle stiffnesss and soreness particularly in the shoulders, biceps and tricepts region, back, calves and thighs. He subsequently developed weakness. He was an avid runner who used to run up to three miles daily and did 100 sit ups per day. He has had these symptoms on and off recently. On 8/3/99, he was started on Medrol DosePak and noted a response after 48 hrs with resolution of his symptoms. He went off the prednisone and his symptoms returned. His physician recommended a referral to a rheumatologist, and the vaccinee was seen on 8/20/99. The vaccinee denied any specific joint swelling, rash, fever, upper respiratory tract infection, dry eyes or mouth, Raynaud's phenomenon, pleuropericarditis, gastrointestinal or genitourinary manifestations, kidney stones, or neurological abnormalities. Physical exam: the muscles were of normal size and strength. The peripheral joints had a full range of painless motion without synovial effusions, tenderness, particularly atrophy. There was no periarticular soft tissue tenderness. Impression: probable Lyme vaccine reaction. Rule out connnective tissue process. The rheumatologist stated that the lack of increased sedimentation rate and the weakness did not correlate with polymyalgia rheumatica. Plan: to obtain a CPK and probably EMG studies to rule out a myopathic process and continue to taper prednisone. 9/16/99 rheumatologist visit: The vacinee had a recent flare with stiffness through the shoulders and less to through the hips after decreasing the prednisone. There was a question of slightly decreased strength through the shoulder abductors. They were tender to palpation. Minimal weakness was detected through the hip flexors. Assessment: Probable Lyme vaccine reaction. Rule out myositis vs. polymyalgia rheumatica. He appeared to have a form of myositis but whether he actually had polymyalgia rheumatica or a mixed connective tissue disease remained to be seen, in one physician's opinion. Plan: "The symptoms apparently occurred after an upper respiratory infection. We are obtaining a CPK and, if elevated, will proceed with EMG studies." (Results not provided). Prednisone was restarted at 5mg. Vaccinee was subsequently hospitalized on 10/11/99 for treatment and evaluation following the development of pain in his chest with dizziness and near syncope. His dizziness had started on 10/6/99 accompanied by unsteadiness and difficulty in concentrating. The symptoms recurred on 10/7/99 and again on 10/9/99 when he was near syncopal. THe dizziness was occasionally associated with nausea and sweating. Blood pressure on admission was 102/97 mmHg. Brain CT scan was performed that was normal. Echocardiogram was performed which revealed ejection fraction of 70% with normal left ventricular chamber dimensions and good systolic function. Discharge diagnoses on 10/13/99 were: near syncopal episode; chest pressure with vertigo consistent with anterior chest wall syndrome; hypertension; history of arthralgia and myalgia. He was placed on Norvasc 5mg po daily and was discharged with a blood pressure of 134/90 mmHg. Other discharge medications included prednisone 5mg daily and meclizine HCL. It was reported on 8/7/00 that the vaccinee was "doing well" and "at this time his symptoms seem to have disappeared." Vaccinee had resumed his exercise program and his blood pressure had been within normal range. Etiology of the arthralgia and myalgia was not clarified.