Age: 39.0
Sex: F
Vaccine: HEP, TTOX, TYP, YF, HEP, TTOX, TYP, YF, HEP, HEPA, IPV, TD, TTOX, YF
Symptoms: Arthralgia, Influenza like illness, Jaundice, Liver function test abnormal, Pain
Clinical narrative: From initial info received on 2/12/04 through an enhanced surveillance program conducted by the Centers for Disease Control and Prevention regarding an adverse event, it was reported that a 39 year old female pt received a first dose of YF-VAX, a dose of TYPHIM VI, a dose of Tetanus toxoid and a dose of hep B vaccine administered on 1/21/04. No other vaccine info was provided. Nine days later, the pt experienced body aches, low grade fever, and flu like symptoms. On 2/2/04, she became jaundiced and the following day she developed macular papular body rash. The pt was hospitalized four days later, on 2/7/04. Her diagnostic tests revealed elevated LFT's. A lumbar puncture was not performed. Tests results for CMV, EBV, paro virus, hep A and hep B were unavailable at the time of this report. As of 2/10/04, the pt was still in the hospital and was said to be improving. At the time of this report, the pt had not recovered from these adverse events. From additional information received on 25/FEB/2004 from the Centers for Disease Control and Prevention, it was reported that the patient's age is 34 years. The reporter stated that the patient "took a turn for the worse on the 12th (the day she was expected to be discharged)" as she developed pneumonia and uveitis. Reportedly, the patient was stable at that time, but her liver function tests remained elevated wtih ALT approximately 200, 100 to 102 degrees Fahrenheit. The results of two serum samples were both negative for yellow fever by TaqMan PCR. At the time of this report, it was felt that the test results suggest that the patinet's illness may be due to another etiology. The patient's recovery status was not reported. From additional information received on 3/4/04, other busines spartner number was provided. No new medical information was reported. Additional information was also received on 3/4/04 from the CDC from the minutes of the Yellow Fever Meeting on 2/9/04. This report had been initially considered as a possible case of viscerotropic disease. Additional vaccinations on 1/21/04 included HEPATITIS A and POLIOMYELITIS VACCINE INACTIVATED. Additional information was received on 3/11/04from the CDC containing updated information obtained during a phone conversation with the patient and her mother. It was reported that on 2/5/04, the patient had jaundice and bloody vomiting. On 2/7/04, she had a diffuse macular papular hemorrhagic body rash (including the palms of her hands), severe abdominal pain plus joint pains polyarticular and was hospitalized. Between 2/13/04 to 2/14/04, physicians confirmed pneumonia with ground glass x-ray (no discrete infiltrate, lungs sounded clear). Several antibiotics were ineffective in reducing x-ray abnormalities. She was discharged on 2/19/04 from the hospital and returned to hospital on 2/20/04 as an outpatient. She was started on Prednisone because of persisting rash and severe generalized joint pains with swelling of some joints. She subsequently returned home. She was admitted to a hospital on 2/22/04 with abdominal pain and high fever and lots of joint pain. An x-ray still showed pneumonia and pleural effusion. As of 2/25/04, she was discharged with persisting but improving pneumonitis, uveitis, and severe joint pains. At that time she was still on prednisone. Her symptoms (mainly arthritis) as of 3/4/04 were slightly worse, as the prednisone dose is being tapered. Information provided also stateed that the patient had not received TETANUS TOXOID as previously reported, but instead received DIPHTHERIA AND TETANUS TOXOIDS. The lot number, manufacturer and administration information for this product were not reported. From additional information received on 5/6/04 from the CDC, it was reported that the body rash also involved the conjuctiva. Upon the patient's discharge from the hospital on 2/25/04, she had uveitis with deteriorating vision. Her rash had improved on prednisone, but was still present at the time of this report. She continues to haev symptoms, even on higher dose steroids. No skin biopsy was done. Her vision was getting worse, but is now better on steroids. Upon tapering the steroids, the symptoms became worse. On 3/31/04, the hospital laboratory agreed to send a convalescent serum specimen, which was collected on 2/23/04, to the CDC for testing. No other information was provided at this time. Further information is not anticipated, this case is considered closed.  From information received on 14Jun04 through an enhanced surveillance program conducted additional lab data was provided. Hep C antibody was negative and blood culture had no growth after five days. For additional lab data, please refer to the relevant diagnostic test/laboratory data (section 12) of the form.