Age: 1.01
Sex: F
Vaccine: HEP, VARCEL
Symptoms: Drug ineffective, Headache, Meningitis, Pain, Pruritus
Clinical narrative: Chickenpox, varicella meningitis.  Rash onset 6/8/2006, headache onset 6/10/2006. 6/27/06-Received office note from pediatrician's office for DOS 6/23/06 as a follow-up to hospitalization. Assessment f/u varicella meningitis. Physical exam revealed FROM of neck, climbs on and off table without problems, residual pox marks on abdomen and between toes. Plan: activities as tolerated, diet as tolerated.  Chief Complaint: Headache and chicken pox for 5 days. June 11, 2006Headache increased in severity and no response from Motrin. Procedures: PICC placement. Allergy: Penicillin PMH: negative PE: Temp 97.5, significant pruritus, lesions on scalp. Mild periorbital erythema. Tympanic membranes clear bilat. 1 pox in right ear canal. Throat: pox lesion anterior on left side of tongue and in left cheek. No tonsillar exudate. No nuchal rigidity. Skin: erythema bilaterally on neck and postauricular regions. Multiple pox marks most crusted erythematous and scab lesions. Approximately 50 lesions. 2 pox marks located on inside of right labia minor. Remainder of PE unremarkable. RX in hospital: IV Rocephin, Vancomycin and Acyclovir. Patient remained afebrile. Itching and pain controlled with Benadryl. Neurological checks remained within normal limits throughout hospitalization. DC on Acyclovir IV.  07/21/06-received ER report for follow-up visit after DC for DX of meningitis and chickenpox. Returned to ER on day of DC with c/o nausea/vomiting/cramping. Current Medications: Acyclovir.  RX in ER with IV Zofran. PE revealed crusted vesicle on face, back and leg. Vesicles on feet.  DX:varicella positive, Herpes negative. krk 07/26/06-Office records from pediatrician received for DOS 6/14-6/30/06.  Continues with headaches but do not require her to stop activities. Question whether headaches are results of LP.  06/22/06-request faxed to Pediatrician's office. krk 06/27/06-request faxed to Hospital. krk 6/27/06-Received office note from pediatrician's office for DOS 6/23/06 as a follow-up to hospitalization. Assessment/u varicella meningitis. Physical exam revealed FROM of neck, climbs on and off table without problems, residual pox marks on abdomen and between toes. Plan: activities as tolerated, diet as tolerated.  7/24/06-DC summary received. Chief Complaint: Headache and chicken pox for 5 days. June 11, 2006Headache increased in severity and no response from Motrin. Procedures: PICC placement. Allergy: Penicillin PMH: negative PE: Temp 97.5, significant pruritus, lesions on scalp. Mild periorbital erythema. Tympanic membranes clear bilat. 1 pox in right ear canal. Throat: pox lesion anterior on left side of tongue and in left cheek. No tonsillar exudate. No nuchal rigidity. Skin: erythema bilaterally on neck and postauricular regions. Multiple pox marks most crusted erythematous and scab lesions. Approximately 50 lesions. 2 pox marks located on inside of right labia minor. Remainder of PE unremarkable. Lab: WBC 10.4 platelets 41, 000, granulocytes 46, lymphocytes 40, monocytes 9. BUN 11, creatinine 0.5. CSF: protein 50, glucose 53, 25 inflammatory reactive lymphocytes, appearance clear. CSF culture few WBC, no organism seen. Herpes simplex 1&2 DNA PCR not detected. Enterovirus not detected by PCR. Blood cultures: negative.  RX in hospital: IV Rocephin, Vancomycin and Acyclovir. Patient remained afebrile. Itching and pain controlled with Benadryl. Neurological checks remained within normal limits throughout hospitalization. DC on Acyclovir IV.  07/21/06-received ER report for follow-up visit after DC for DX of meningitis and chickenpox. Returned to ER on day of DC with c/o nausea/vomiting/cramping. Current Medications: Acyclovir.  CBC and Chem WNL, Ca 10.0. RX in ER with IV Zofran. PE revealed crusted vesicle on face, back and leg. Vesicles on feet.  DX:varicella positive, Herpes negative.  07/26/06-Office records from pediatrician received for DOS 6/14-6/30/06.  Continues with headaches but do not require her to stop activities. Question whether headaches are results of LP. No additional costarts will be added.