Age: 28.0
Sex: M
Vaccine: FLU(H1N1), FLUN3, HEPAB, MNQ, TDAP
Symptoms: Barium swallow normal, Blood albumin decreased, Blood calcium decreased, Blood creatine phosphokinase increased, Blood creatinine normal
Clinical narrative: The pt arrived on 1/4/10. He received multiple vaccinations on 1/5/20 at which time he was healthy. He had no adverse reactions. On 1/7/10 he noted that he felt feverish, chilled, had a sore throat, rhinorrhea, slight cough, and body aches which lasted about 4 days. There were other people around him who were also sick. On 2/12/10 the pt received multiple vaccinations. On 2/14/10, the patient experienced fever, chills, diaphoresis, severe sore throat, cough and generalized body aches. He does not recall that others were also sick. On 2/20/10 the pt noted numbness on the bottom of his feet and his fingertips. 2/21/10 he also noted numbness of his lips, tongue and blurry vision. On 2/22/10 he was treated in the ER for a sinus infection and was instructed to follow-up in the am for his neurological symptoms. On 2/23/10 the pt was seen in medical for a headache, blurry vision and numbness/tingling of the bottom of his feet, mouth, and fingertips. The pt was evaluated by a neurologist. PE revealed "stocking loss of sensation in association with areflexia in the legs; subtle breakdown in smooth pursuits coinciding with blurred vision." A NCS was performed. It was felt that the pt most likely had Guillain-Barre syndrome but his symptoms were so mild that treatment was not warranted so the pt was returned went to work with instructions to f/u in 2 days. The pt returned to medical on 2/24/10 with complaints of headache, difficulty walking, numbness in his calves, anus, scrotum and worsening of his blurry vision. He denied bowel or bladder incontinence but he did have urinary hesitancy. The pt was reevaluated by the neurologist and released due to "no progression in his paresthesias". The patient was admitted to the hospital for observation. The physical exam revealed distal areflexia, ataxic gait, instability with Romberg testing, muscle strength and tone was 5/5 and symmetric in BLE/BUE. Over the next 48 hours the patient's symptoms progressed to include onset of LBP, generalized myalgias, perioral and facial numbness, difficulty managing his oral secretions and coughing with intake of liquids. On 2/26/10 PE revealed normal BLE/BUE muscle strength and tone, weakness of facial muscles, diminished corneal reflexes, mild dysarthria. The pt was transferred to another hospital with complaints of numbness of his finger tips, feet, legs, hips, pelvis, abdomen up to the rib cage, and difficulty swallowing and talking due to numbness of his mouth and lips, and blurry vision. He was diagnosed with Miller-Fisher variant of Guillain-Barre syndrome. The pt was treated with IVIG 0.8mg/kg daily for 3 days. As of 3/8/10 the pt's headaches were being treated with IMITREX, there was improvement of the facial paresis and pt was ambulating with a cane. Symptoms: numbness, dysphagia, headache, general, numbness, numbness, blurred vision, numbness, fever, chills, diaphoresis, pain, muscle pain, cough, productive, fever, chills, pain, nasal drainage, cough, productive, muscle pain.