Age: 37.0
Sex: M
Vaccine: FLUN3
Symptoms: Angioedema, Anti-thyroid antibody positive, Antinuclear antibody negative, Blood thyroid stimulating hormone increased, C-reactive protein normal
Clinical narrative: This 37 year old officer received an annual FLUMIST administration on 05 October 2006.  (records receipt of both IM and nasal influenza;  however pt advises he received nasal).  Two prior vaccinations with intramuscular Influenza (2002-2003) resulted in no remembered adverse events.  Within 12 hours following his October 5th FLUMIST he began to experience "low grade fevers" lasting 12-24 hours.  No other adverse events were remembered.  Other vaccinations received after FLUMIST included TYPHOID vaccine and a PPD skin test on 23 October 2006.  Approximately 25+ [[name]]s FLUMIST (@ 30 October 06) and 6 [[name]]s post TYPHOID vaccination with a negative PPD reading he went to city (Oct 29-Nov 1, 2006) with his family on vacation.  While there he noticed a "mosquito like bite"  to his left elbow/forearm region.  He described a [[name]] circular bump 1-2cm in size, pinkish coloration that was mildly pruritic.  There was no identifiable [[name]].  It lasted a few hours to a few [[name]]s resolving spontaneously without medication.  This bump would reoccur a few times a week with satellite bumps that radiated to his waist/stomach (initially waist band area then al over), inner thighs, groin, back, and down lateral sides under axilla bilaterally.  He thought he was having a reaction to some soap, detergent, or deodorant, etc following his recent vacation and changed deodorants, detergents, etc without resolution.  He began to notice red raised confluent hives described up to 2 inches in diameter.  About Nov 1-2, 2006 he awoke with pruritic hives covering his body.  He denied any respiratory distress or problems swallowing and began BENADRYL 50 mg for 2 [[name]]s with resolution of the hives after the first dose.  Attempts to discontinue BENADRYL resulted in reoccurrence of hives so he began routine use three times a [[name]].  By 13 Nov 2006 while working, his hives worsened and he was treated by Dr with a diagnosis of urticaria/hives.  He was placed on ALLEGRA x 1 week with initial "good response" with reoccurrence of symptoms one week later.  In December 2006 he was referred to Dr, allergist at agency and placed on ZYRTEC.  He reported one episode of facial angioedema on 15 Dec 2006 and was seen in the emergency room at Hospital.  He was given a 5 [[name]] course of oral PREDNISONE with resolution of symptoms.  He was re-evaluated by Dr. on 18 Dec 2006 without change status (hives resolved if on ZYRTEC otherwise present).  12 Feb 2007 his initial evaluation by Dr, allergist at agency diagnosed idiopathic urticaria of unknown etiology.  Dr could not rule out autoimmune component (l.e. anti -Fc epsilon RI antibody).  He was referred to the Center for follow up evaluation on possible association of rash after FLUMIST vaccination.  A follow up interview on 21 Feb 2007 reported this service member had tried stopping ZYRTEC during a recent 3 [[name]] long weekend with the rash/hives returning to his inner thighs as itching then 1 inch hives which progressed up abdomen with arms having [[name]] red raised bumps.  Symptoms resolve within a few hours after taking 10 mg ZYRTEC orally and remain well controlled on ZYRTEC.  Follow up evaluations with Dr identified elevated TSH 5.08 (0.27-4.20), thyroglobulin Ab 53 (0-20) and thyroperoxidase 537 (0-35);  normal FT4 and abnormal ESR 66 (1-19).  A diagnosis of "idiopathic urticaria with mild CIU and possible hypothyroidism trigger:  and hypothyroidism was electrophoresis, and CRP levels.  Repeat ESR, TSH, & FT4 were all normal.  Subsequent evaluations from 2007-2009 reported resolution of rash with treatment for hypothyroidism with synthroid.  On 07 Nov 2008 he received IM influenza with no adverse events reported (no rash).  Symptoms:  Lesions, papule, Rash, pruritic, Erythema.