Age: 34.0
Sex: F
Vaccine: RAB, TTOX, RAB
Symptoms: Dehydration, Diarrhoea, Headache, Hypoaesthesia, Tremor
Clinical narrative: A 34 year old female patient, who was bitten by a cat, experienced dehydration with associated symptoms of dry mouth, dizziness, diarrhea, nausea, weight loss and fatigue. She also experienced neurological disorders with associated symptoms of insomnia, headache, quivering without fever, sweats, or chills, loss of consciousness, hot sensations from toes to neck, tremors, feeling of her arms going numb, tinnitus, burning pain down her spine and legs that moved up to her chest with squeezing feeling around the blood vessels of her heart, and seeing black fuzz on her eye lens after treatment with RabAvert. Her past medical history was significant for hypoglycemia. The patient received RabAvert day 0 on 7/19/04, day 3 on 7/21/04, day 7 7/25/04 and day 14 on 8/1/04. Concomitant medications included Elavil, Neurontin, Skelaxin, Vancocin, Alpralezam, Benadryl, Tylenol, Doxycycline, IV fluids, tetanus toxoids, Ciprofloxacin, and Clindamycin. On 7/19/04 the patient was bitten on the finger by a stray cat that looked sickly. Her physician prescribed ciprofloxacin and clindamycin for 3 days. On 7/21/04 the patient sprained her ankle and went to the emergency room. During the visit the ER physician initiated post exposure treatment for rabies prophylaxis. The patient was given Human Rabies Immunoglobulin, a tetanus shot, and rabies injection number one. The next day she was ok but passed out that night. On 7/21/04 the patient received the second dose of RabAvert. After this dose on 7/22/04 the patient had an increased headache across the back of her head from ear to ear. The headache lasted until 8/31/04. The third dose was received on 7/25/04. On 7/31/04 she again experienced diarrhea, twitchy feeling, quivering without fever, sweats or chills, but with hot sensations from her toes to her neck, feeling like her arms were going numb, ears ringing, feeling like passing out and feeling like her tongue was stuck to the roof of her mouth due to dryness. Late that night she went to the local hospital where she was admitted for 2 days starting on 8/1/04 and treated for dehydration with IV fluids and Imodium. The patient had a consult with an infectious disease physician who told her the symptoms were not due to the rabies vaccine but that she should take the fourth dose. The patient received the fourth dose on 8/1/04 and was discharged on 8/3/04. On 8/5/04 the diarrhea resumed and the patient was told to take Imodium and Pepto-Bismol. This controlled the diarrhea but the headache and twitches, numb arms and ringing in the ears returned. In addition, she also complained of feeling electrical currents running down her spine and legs. The patient went back to the ER where blood was drawn for West Nile Virus. Lyme disease and other unspecified tests. She was treated for 6 hours with IV fluids and discharged home with Tylenol and codeine for sleep. She was told she might have stress and muscle spasms. All tests were negative. The headache persisted all the day with burning pain down the spine. On 8/8/04, she was treated with Benadryl, Tylenol, and doxycycline. Blood tests for Lyme disease and Burgeria were negative. On 8/12/04 the diarrhea started again so bad that the patient was on the bathroom floor in pain along with nausea and severe headache. The tremors began to feel less twitchy and more like electric currents throughout her body, especially from her neck to her spine. Vancocin was prescribed for infectious diarrhea, which relieved the diarrhea. On 8/16/04 the patient saw a neurologist who examined the MRI of her head, which was negative. The cervical spine showed minor disc bulging and dryness. Thoracic and Lumbosacral MRI's were ordered. Neurontin and Skelaxin were prescirbed. On 8/18/04 she discontinued Neurontin due to negative side effects. On 8/20/04 the headache was severe and electric currents recurred. On 8/23/04 the patient returned to the ER for a headache. Her blood pressure was 100/60. She was given an injection of Demerol which relieved the pressure in her head but not the pain or quivers. On 8/27/04 a spinal tap was performed. The results were negative for meningitis. She was placed on 6 days of methylpredinsolone which provided some relief. On 8/30/04 the patient went to a headache clinic and was told by the physician that he could not determine the cause of the headache and prescribed Elavil for depression. On 9/1/04 around 5 PM the patient started having headaches and tremors again. The electrical currents that were running down her leg and spine moved up to her stomach, chest and esophagus area and were described as a squeezing feeling around the blood vessels in her heart. Since the start of these events the patient reported a weight loss of 10 pounds. The patient is receiving electrical stimulation therapy for the bulging, dry discs. The diarrhea, tremors, headache, numbness in arms, electrical current down the spine, black fuzz on lens and fatigue were reported as partially recovered.