Age: 1.25
Sex: F
Vaccine: VARCEL
Symptoms: Abdominal distension, Alanine aminotransferase increased, Aspartate aminotransferase increased, Bacterial infection, Blood albumin decreased
Clinical narrative: On 12/26/00, the child was admitted to the hospital. At the time of admission the child apparently had 2 lesions, though at the time of admission, the significance of the lesions was not noted. The child also had a fever of 102. On 12/26/00, the pt was placed on the combination of vancomycin and piperacillin/tazobactam. Cultures from the  central line were positive for Coag negative staph sensitive to oxacillin. A culture from the draining PEG grew methicillin resistant staph aureus. By 12/28/00, the child had developed at least 50 generalized lesions and was started on IV acyclovir. After 12/28/00, the child gradually developed small crops of lesions predominately on the extremities and in the diaper area. On 12/28/00, the child had a pediatric ID consultation. The physician noted that the child in general was alert and in no distress and was able to walk. Her height and weight were greater than 95% for her age. The child suffered from alopecia. Extraocular movements were intact. Red reflexes noted bilaterally. The sclarae are anicteric. Tympanic membranes were gray and had a normal light reflex. The pt had mild nasal congestion and a small amount of nasal discharge. There were no oral lesions and the pharynx was benign. Her neck was supple. The pt's abdomen was soft and somewhat distended, occasional bowel sounds were noted. A PEG button was in place and there was some crusting but no drainage. There were numerous vesicular lesions scattered throughout her skin and were located in the  extremities on the torso, on the scalp and most prominently in the area of the diaper. In total there were approximately 40-50 lesions which appeared to be at various stages. A few were crusted over, others had a more vesicular appearance. The pt's cranial nerves were intact. The pt was found to be VZV positive. As of 1/4/01, the physician indicated that the child is clinically stable and appears to be doing well. The physician indicated the child had a generalized vesicular rash, classic for varicella. It is probable that the varicella is secondary to the administration of the live viral vaccine to and immunocompromised child. A particular concern is the rising transaminases which appear temporally correlated with the administration of the vaccine. This may indicate a dissemination of the varicella. No further information is available. Follow-up info received from a physician on 4/24/01, indicated that as the pt was discharged from the hospital and has recovered from her experiences. He indicated that he is no longer following her as an outpatient. The physician reported that since 1/01, the pt has been followed in an outpatient clinic at the hospital for her autoimmune enteropathy. The records indicate she is doing well at home and has not been on any antiviral agents or had any sequelae from her adverse experiences in 1/01. The physician stated that according to hospital records, lesion specimens on 12/20/00 and 1/2/01 were positive for varicella; however, he could find no record that any PCR was done to differentiate between wild-type or vaccine strain VZV. No further information is available.