Age: 12.0
Sex: F
Vaccine: FLUN3
Symptoms: Immunodeficiency common variable, Influenza, Infusion, Pain, Pneumonia
Clinical narrative: Typical flu symptoms of fever, chills, and aches were shown the next day.  She then ended up with pneumonia the following week.  She continued to have repeated upper respiratory infections, sinus infections, pneumonia 3 times, ended up having 3 sinus surgeries due to severe infections, 3 bronchoscopies, 4 hospital stays of no less than 8 days, and has now been diagnosed with Common Variable Immune Deficiency and has to receive IVIG infusions every 4 weeks for the rest of her life.  She had never been a sick child until she received the Flumist.  Once she received the Flumist she was not well again until about 10 months later when she started receiving infusions.  She missed 58 days of school in her 7th grade year.  I regret ever giving her the Flu vaccine. 10/16/09 Discharge Summary received for Dates of Service 12/10/08-12/19/08.  Dx:  Acute tracheobronchitis, acute sinusitis, severe reflux, persistent cough, cat allergy, subclass hypogammaglobulinemia. Assessment:  Admitted with chronic cough, placed on continuous areosols for 12 hours then switched to Q 2 hrs.  Zithromax started. Started on Symbicort with a spacer and IV ceftriaxone.   PIC line was inserted for IV antibiotics.  Placed on Solu-medrol BID.  Pt. trained in vocal cord dysfunction techniques.  Reglan started for reflux.  Underwent sinus clean-out, cough improved significantly.  Lungs CTA. Discharged on Symbicort, Pulmicort, Zyrtec, IV rocephin, Flonase, Prevacid, Xoponex and Atrovent. 10/16/09 Discharge Summary received for Dates of Service 2/6/09 to 2/14/09.  Dx:  Acute bronchitis due to strep viridans and Prevotella species, recurrent bronchitis, chronic reactive airway disease, chronic and recurrent sinusitis, IgE subclass I deficiency plus low IgG total and low IgA total, Intermittent costochondritis, mild scoliosis.   Assessment:  Admitted with persistent cough, fever, chest pain and failure to clinically improve with oral antibiotics and aggressive aerosol bronchodilator therapy as an outpatient.  Underwent flexible bronchoscopy for lavage.  After bronchoscopy chest with moderate congestion, wheezing and ronchi.  Given EES film tabs to decrease mucous production in the lungs.  Hematology consult done due to low white blood cell count.  Underwent aggressive pulmonary therapy every 3-4 hours and was discharged home with mild ronchi in the right axilla and right lower lobe area and faint expiratory wheezes on forceful expiration present only on the right side. Her condition was markedly improved from admission.   10/16/09 Discharge Summary received for Dates of Service 4/20/09 to 5/03/09.  Dx:  Asthma exacerbation, acute sinusitis, Immunodeficiency:  IgG subclass deficiency, allergic rhinitis, gastroesophageal reflux disease, chronic bronchitis. Assessment:  Worsening respiratory status characterized by cough, sore throat, fever, not improved with bronchodilators.  Put on Xoponex continuous and systemic steroids as well as Omnicef daily.  Endoscopic sinus irrigation and lavage performed, placed on Zosyn for positive cultures.  At discharge afebrile, normal mental status, good oral intake, stable on room air.   10/16/09 Discharge Summary received for Dates of Service 5/15/09-5/22/09.  Dx:   Drug reaction to IV Zosyn, manifested by fever, decreased white count, decreased platelets, increased liver function tests and rash.  Common variable immunoglobulin deficiency on intravenous gamma globulin as an outpatient.  Chronic asthma, stable, allergic rhinitis, stable, chronic sinusitis, mildly active.   Assessment:  Stomach upset, decreased energy and stamina.  Stepfather had been positive for influenza.  Temperature accompanied by shivers and chills.   Rash became confluent over chest, back, abdomen and extremities.   treated with a gamma globulin infusion.  LFT's began to trend downward when Zosyn was stopped.  Condition at discharge improved from that at admission.  Afebrile x 48 hrs.