Age: 18.0
Sex: M
Vaccine: MMR, TD, YF, MMR, TD, YF
Symptoms: Eye pain, Laboratory test abnormal, Myelitis, Optic neuritis, Sensory disturbance
Clinical narrative: It was reported that an 18 year old male pt who received Yellow Fever, TD and a MMR vaccines on 7/26/02. He had previously received Meningococcal vaccine, IPOL vaccine and hep A vaccine on 6/27/02. Approximately 20 days after receiving Yellow Fever, TD and MMR vaccines, the pt experienced blurred vision and eye pain, which also progressed to inability to void and decreased sensation to his lower extremities. On 8/25/02, the pt was admitted  to the hospital and he spent three days there. He was diagnosed with Devic's syndrome and had optic neuritis and myelitis. He improved dramatically with steroids and had outpatient rehabilitation to regain full mobility. He had no recurrences of his illness and fully recovered. The CDC has requested medical records. No other info was provided. From initial information received 28/Dec/2003 through an enhanced surveillance program conducted by the Centers for Disease Control and Prevention (VAERS 214072), regarding an adverse event occurring in the U.SA., it was reported that an 18-year-old male patient in the Coast Guard received Yellow Fever Vaccine, Dipheria and Tetanus Toxoids and a Measles mumps and rubella vaciine (lot numbers, routs, and sites of administration not reported) on 26/Jul/2002. He had previously received Meningococcal vaccine, poliomyelitis vaccine inactivated and Hepatitis A vaccine (lot numbers, routes and sites of administration not reported) on 27/Jun/2002. Approximatley 20 days after receiving Yellow Fever vaccine, Diphtheria and tatnus Toxoids and a Measles, Mumps and Rubella vaccine, the patient experienced blurred vission and eye pain, which also progressed to inability to void and decreased sensation to his lower extremities. On 25/Aug/2002, the patient was admitted to the hospital and spent three days there. He was diagnosed with Devic's syndrome and had optic neuritis and myelitis. He improved dramatically with steroids and had outpatient rehabilitation to regain full mobility. He had no recurrences of illness and fully recovered. The CDC has requested medical records. No other information was provide. From additional information received on 20/Jan/2004 from another manufacturer, their case number was provided (WAES 0312USA02755). No other information was reported. Follow up on 06/11/04 states: "Follow up information received from an agency (VID 214072) reported that the pt was 19 years old at the time of vaccination, other relevant history noted as none and adverse event onset was one month after having a "common cold". On 08/14/02, 19 days post immunization he awoke with bilateral eye pain, which was not accompained by visual impairment, as well as, blurry vision bilaterally with the right worse than the left. His vision deteriorated until he could not see with his right eye. He also developed right leg numbness, right arm tingling, neck stiffness, difficulty urinating and fever. The pt saw his primary care physician on 08/25/02 and was referred to an opthalmologist. An orbital MRI displayed bilateral retrobulbar optic neuritis. A whole spine MRI showed multiple lesions all over his spinal cord. He was admitted to the hospital on 08/25/02 by the neurology service of the hospital. Hospital lab evaluation revealed: CSF RBC 7, WBC 465, Lymphocytes 85%, Glucose: 54, Protein 117 VDRL negative, oligoclonal bands negative. Lab evaluation also revealed: WBC 21, H/H 13.2/40; Plts 468; rheumatoid factor negative; Anti dsDNA negative; HIV negative; Sed rate 25; TSH normal; sodium, potassium chloride, CO2, glucose, BUN, creatinine all normal; MRI on 08/25/02 showed abnormal enhancement and enlargement involving the optic nerves as well as multiple areas of abnormal enhancement and enlargement involving the optic nerves as well as multiple areas of abnormal signal in the spinal enlargement involving the optic nerves as well as multiple areas of abnormal signal in the spinal cord and brain stem. Initial physical examination revealed neck stiffness on forward bending and several small palpable lymph nodes in the right posterior cervical area. Pupils were 6mm on the right and 5mm on the left. Pupillary light reflex was sluggish, with APD on the right and prompt on the left. Vision 20/400 on the left and unable to count his fingers on the right. He experienced tenderness with full extraocular movements. Strength was 4+/5 of left hip flexion. He had hypesthesia and dysthesia to pinprick below the right T6 level and possible hypesthesia to pinprick below left T10. Additionally, he had gait dragging on the left side, but was able to walk on his heels and toes. He was unable to stand on either the right or left foot alone and was unable to perform tendem gait. He was treated with IV methylprednisolone sodium succinate (Solu-Medrol) 1000mg for 2 days. His visual symptoms improved dramatically with treatment and his visual acuity was restored almost to baseline. The pt was able to void successfully. His unsteadiness improved, but the numbness remained unchanged. The pt was discharged home on prednisone and protonix on 08/27/02.  He was seen for follow up examination on 09/18/02 and had areas of patchy light touch and pinprick sensory loss from the mid-anterior thigh and distally. The area of transition from normal to abnormal sensation was approximately 3-4cm proximal to the bilateral patella. He was placed on prednisone and azathioprine. He had a normal examination on 09/20/02.  On 11/25/02 an MRI revealed cervical and thoracic spine normal. On 01/22/03 (reported as 2002) exam was normal. On 01/22/03 the pt physician recommended against receiving the smallpox vaccine. On 05/20/03 he had a normal examination and continued to taper prednisone and azathiopine. On 11/21/03 the pt was off of the prednisone and azathioprine and had a normal exam. The pt was still int he coast guard at that time. Follow up information received from the agency reported that the outcome of this case was reported as "suspect YEL-AND with autoimmune involvement". No further information anticipated. This case was considered closed." He was treated with IV Solu-Medrol 1000 mg for two days. His visual sxs improve dramatically with treatment and his visual acuity was restored almost to baseline. The patient was able to void successfully. His unsteadiness improved, but the numbness remained unchanged. The patient was discharged home on prednisone and Protonix on 27AUG2002. He was seen for follow up examination on 18SEP2002 and had areas of patchy light touch and pinprick sensory loss from the mid anterior thigh and distally. The area of transition from normal to abnormal sensation was approximately 3-4 cm, proximal to the bilateral patella. He was placed on prednisone and azathioprine. He had a normal examination on 20SEP2002 and 22JAN2002.  On 22/JAN/2003, the pt's physician recommended against receiving the smallpox vaccine. On 20MAY2003, he had a normal examination and continued to taper prednisone and azathiopine. On 21NOV2003, the pt was off of the prednisone and azathioprine and had a normal exam. The pt was still in the Coast Coast at that time.