Age: 59.0
Sex: F
Vaccine: LYME
Symptoms: Headache, Influenza like illness, Muscle disorder, Myalgia, Weight decreased
Clinical narrative: Report 2001021398-1 described dehydration due to diarrhea in a 59 year old female who received Lyme disease vaccine OspA recombinant (Lymerix) for prophylaxis of Lyme disease. This report was received from the vaccinee and has not been verified by a physician or other health care professional. Reportedly, the vaccinee was allergic to IV pyelogram dye, dextropropoxyphene hydrochloride (Darvon), and "caines", chocolate and nuts. Reportedly, she had no medical history and took no concomitant medications. Reportedly, she was never diagnosed with Lyme disease. On 02/19/01, the vaccinee received her 1st left arm dose of Lymerix. Reportedly, 36 hours later, she developed diarrhea, which got progressively worse. On 03/05/2001, two weeks post-immunization, she was experiencing diarrhea which reportedly occurred six to eight times daily. Additionally, at this time, she reported that she developed flu-like symptoms, headaches, and muscle pain in the cervical area. The muscle pain in the cervical area would resolve, and the muscle pain would move to the thighs. Reportedly, she never experienced joint pain. She was treated with anti-diarrhea medications and a BRAT (bananas, rice, applesauce and toast) diet with no no results. An ultrasound of the abdomen was performed. The results were reportedly "normal". A gastroenterologist admitted the patient into the hospital on 03/20/01. Reportedly, inpatient testing consisted of stools for occult blood, thyroid levels and "other labs" (results unknown). CT of the abdomen was reportedly "normal". She was treated with IV antibiotics. The patient reported that a diagnosis of dehydration due to diarrhea was made. She was discharged from the hospital on 03/22/01. Her weight decreased from 126 lbs to 108 lbs in one month. She was scheduled to have a "H.D.D.A Scan (3) abdominal" on 05/07/01. As of 05/07/01, reportedly, her diarrhea persisted (she was having three to six bowel movements per day), she was fatigued, and she experienced muscle loss in her thighs and arms due to weight loss. The patient stated that she had been out of work since experiencing the above mentioned adverse events. Reportedly, her symptoms prevented her from working as a horticulturist. She stated that she has recently applied for disability and is considering applying for worker's compensation. F/U this report has been verified by a physician. F/U 3/19/01 (gastroenterologist visit): colonoscopy revealed evidence of hemorrhoid. No colon tumor or any mass lesion was seen at that time. For the past month, the pt had periods of diarrhea and severe abdominal pain. She had been treated with antibiotics (NOS), as well as, with lansoprazole (Prevacid) with no signigicant relief. The diarrhea persisted as of 3/19/01. She also complained of weight loss, recurrent moderate to severe abdominal pain in the epigastric area with early satiety. There was no dysphagia. She had no history of fever or chills and no history of rectal bleeding. Mild tenderness in the epigastric area was noted on physicial exam. Impression: persistent diarrhea could be related to inflammatory bowel disease or infectious enterocolitis or c. Diff. colitis. Plan: at this time will obtain stool for C diff., CBC with diff, CMP antigliadin, antiendomysial antibodies, colonoscopy exam. 3/29/01 (gastro visit): The pt had recently undergone colonscopy exam and no colitis or Crohn's ileitis was noted at that time. There was no evidence of malnutrition. However, the pt continued to lose weight and the abdominal pain had returned, in spite of symptomatic treatment. Workup for celiac disease was also essentially unremarkable, other than minimal increae in transglutaminase. In view of the above due to the pt to undergo upper GI (gasroentestinal) endoscopy. 4/24/01 (gastro visit): the physician stated that extensive workup had been unremarkable. The possibility of Whipple disease was suspected on biopsy and the physician was awaiting a second opinion. The pt also was in the process of obtaining MRI for pancreas and cyst in the L hypochondriac area. There was no history of hematemesis. Other than decreased weight, the physical exam was essentially unremarkable. Impression: possibility of rare infection, celiac disease, Whipple or other bacterial overgrowth are in the differential diagnosis. 5/1/01 (gastro visit) the pt was taking loparamide hydrochloride (Imodium), colestyramine (Questran), and antispasmodic medication (NOS). She was eating a gluten free diet and avoiding fat. Diarrhea seemed to be improving. Abdominal pain was somewhat decreased, since the previous visit, she was feeling somewhat better, MRI performed was reportedly unremarkable other than for cyst in the left lobe of the liver. The gastroenterologist had not yet rec'd the final small intestine biopsy report or the final MRI report. There was no istory of dysphagia. Recent blood  work (NOS) revealed no evidence of nuritional deficiency or anemia. Symptomatic treatment was continued. As of 8/6/01, the outcome of the adverse events was unknown. F/U as of 8/28/01, the outcome of the adverse events was unknown.