Age: 0.18
Sex: F
Vaccine: DTAPIPVHIB, HEP, PNC, RV5, DTAPIPVHIB, HEP, PNC, RV5
Symptoms: Blood culture negative, Blood product transfusion, C-reactive protein increased, CSF cell count normal, Coronary artery aneurysm
Clinical narrative: Information has been received from a nurse concerning a 60 day old female who on 05-DEC-2008 was vaccinated with one dose of ROTATEQ (lot number not reported) 2ml oral. Concomitant therapy included RECOMBIVAX HB (manufacturer unknown), PENTACEL and PREVNAR. On 08-DEC-2008 the patient became sleepy with rectal temp of 101.1 after receiving ROTATEQ. On 09-DEC-2008 the parents reported the patient was lethargic, alert but not oriented or smiling and not responsive to parents with a rectal temperature of 100.2. The infant was admitted to hospital on 09-DEC-2008 until 10-DEC-2008 she was sent home on antibiotics. On 11-DEC-2008 the patient was seen by physician had red eyes with slight fever. Then on 15-DEC-2008 the child was seen by her physician for diarrhea, her white blood cells were up, red swollen eyes and a temperature of 102 rectally. The patient was admitted to the same hospital again on 15-DEC-2008 and the urinalysis (UA) test and urine culture (UC) were both negative and but she was found to be positive for respiratory syncytial virus (RSV). The patient was discharged on 19-DEC-2008. On 21-DEC-2008, the patient had a temperature of 103 and on 23-DEC-2008 a temperature of 101 in addition to a positive urinary tract infection (UTI) and eyelids continued to be red and swollen. On 23-DEC-2008 the patient was seen by ophthalmologist and a gastrointestinal (GI) specialist. On 24-DEC-2008 they ruled out conjunctivitis and the patient had a temperature of 101. On 25-DEC-2008 the patient was admitted back to hospital for loose stools, high temperature and diarrhea. In the hospital the patient was diagnosed with tachycardia a systolic murmur, areas of the coronary artery were concerning for aneurysm and she had erythema and vasculitis on the right eye. The patient was diagnosed with KAWASAKI disease and given 2 doses of intravenous immunoglobulin (IG), started on aspirin therapy and discharge on 01-JAN-2009 on half baby aspirin a day. Since discharge, the patient was being followed by infectious disease, cardiology and rheumatology. The child had been showing abnormal head ultrasounds since. Chenodeory cholic acid (CDC), spinal tap, brain magnetic resonance imaging (MRI) and full cardiac workup were performed with no result reported. Additional information has been requested.  3/19/09 MR received for DOS 12/15-19/2008 and 12/25-30/2008 with Final DX:  Kawasaki Disease.  Pt initially presented in ER 12/9/08 with c/o fever and increased sleepiness.  Sepsis w/u (-). Pt tx with abx and d/c-somewhat improved. Returned to PCP 12/15/08 with c/o bilateral eyelid erythema, congestion and rhinorrhea. PE (+) for conjunctivitis. Referred to ER for admission.  Admitted for UTI and to r/o sepsis.  Developed erythematous rash on the face and trunk spreading pedally. DX: RSV Bronciolitis. Again tx with abx and d/c. Continued with intermittant fevers.  Returned to ER with c/o fever, listlessness, pallor, tiredness and loose stools. PE (+) for sleepiness, subungual erythematous lesion on L 4th digit, R eyelid violaceous and edematous, rhinorrhea, tachypnea (RR=52), upper airway congestion, subcostal retractions and systolic murmur 1/6.  Admitted for FUO and anemia.  Rheumatology consult dx Kawasaki. Tx with IVIG and ASA with improvement noted. D/C for outpt f/u.