Age: 27.0
Sex: F
Vaccine: FLUN(H1N1), FLUN(H1N1), FLU3
Symptoms: Urinary retention, Viral test negative, Visual evoked potentials normal, Vitamin B12 normal, West Nile virus test negative
Clinical narrative: A serious, spontaneous literature report of longitudinally extensive transverse myelitis has been received from a physician concerning a 27-year-old female, four days subsequent to H1N1, INTRANASAL. The patient's past medical history included remote cervical spine fusion. The VAERS case 373104 lists treatment for mycoplasma pneumonia on 05-Nov-2009. The patient has no family history of autoimmune disorder. The patient was not receiving any concomitant medications. The patient received H1N1, INTRANASAL on 20-Nov-2009. Four days following vaccination the patient experienced a two week episode of back, left hip and lower extremity pain with gradual weakness and paresthesias of the legs, accompanied by urinary retention. The symptoms progressed to involve all extremities and ultimately an inability to stand, when on 09-Dec-2009 the patient's legs buckled while diapering a child and she had difficulty coming to her feet. The patient experienced increased tingling and burning in the hands and difficulty opening jars. The patient reported no prior neurological symptoms or gastrointestinal illness preceding the onset of symptoms. Per the VAERS cases 373104, the patient was treated for mycoplasma pneumonia on 05-Nov-2009. Examination revealed mild proximal muscle weakness with mildly diminished sensation of the upper extremities as well as moderate proximal weakness with profound sensory loss in the lower extremities. Sensation was also moderately diminished on the trunk, with a T4 sensory level. There was diffuse hyperreflexia. Plantar response was silent and no clonus was noted. Magnetic resonance imaging revealed extensive intramedullary nonenhancing T2 hyperintensity extending from the cervical medullary junction throughout the length of the thoracic cord. Brain magnetic resonance imaging results were negative for demyelinating lesions. Results on nerve conduction studies of all extremities and visual evoked potentials were normal. Laboratory testing revealed negative results for serum angiotensin-converting enzyme, antinuclear antibody, rheumatoid factor, neuromyelitis optica antibodies, and human immunodeficiency virus, Lyme disease, and West Nile virus serologies. Epstein-Barr virus, cytomegalovirus, and mycoplasma IgG results were positive, but their respective IgM results were negative. Mycoplasma IgG was elevated at 1.22 on 10-Dec-2009. Sedimentation rate and vitamin B12 levels were normal. Cerebrospinal fluid had a protein concentration of 0.223 g/dL, a glucose concentration of 41 mg/dL, and a white blood cell count of 517/uL with 98% lymphocytes. Bacterial, fungal, and viral culture results were negative. No oligoclonal bands were present. Following treatment with daily intravenous methylprednisolone (1g/d) and plasmapheresis both for five days followed by slow taper over six weeks, symptoms significantly improved. The patient is recovering from the event of longitudinally extensive transverse myelitis, with mild residual paresthesia in distal bilateral lower extremities. The reporter assessed the event as related to H1N1, INTRANASAL, following elimination of alternative etiology for the event. Please reference matching VAERS ID 373104.