Age: 16.0
Sex: M
Vaccine: VARCEL, VARCEL
Symptoms: Blood immunoglobulin G, Blood immunoglobulin G normal, Blood immunoglobulin M, Dermatitis bullous, Diphtheria toxin antibody absent
Clinical narrative: 15 year old admitted to long term care on 01/25/04.  Varicella titer negative on admission.  16 days status post Varivax, developed 10 varicella zoster lesions with fever.  19 days status post Varivax, return of fever and developed >100 varicella lesions.  No known exposure. 02/11/2010 Information has been received froma physician and literature articles concering a 16-year-old male who resides in a pediatric long-term care facility with profound mental retardation secondary to near drowning in childhood, spastic quadriplegia, a seizure disorder, recurrent aspiration pneumonia ("frequent bouts of pneumonia that were greater in number than might be expected for such a profoundly disabled child"), gastroesophageal reflux diesase, and a history of status-post gastrostomy tube insertion, Nisssen fundoplication pylorosplasty and tracheostomy. The patient was noted to be non-ambulatory and dependent on caregivers for all activities of daily living. It was also niteed that the patient had not problems with any other infectious conditions, no evidence of any specific immunosuppression adn had not history of  varicella. On 28- JAN-2004, the patient was vaccinated SCwith the first dose (0.5 mL) of VARIVAX (Lot #640071/1017L). Concomitant medications included KLONOPIN, GUIATUSS, DEPANOTE, LAMICTAL, MIRALAX, tobrmycin andvalproic acid. The patient was on no routine steriods. On 12-FEB-2004, the patient developed a fever and less than 15 vesicular lesions (also described as a disseminated rash consistent with chickenpox). Unpsecified medical attention was sought. VIV IgG testing on 18-FEB-2004 was negative. On 02-MAR-2004, the patient developed greater than 500 varicella lesions and his fever rose to 103 degrees and persisted 4 days and then resolved without sequelae. The patietn was treated empirically with clindamycin and caftriaxone. An immune work-up was normal including serum quantitiative IgG, diptheria antitoxoid antibody, negative HIV, normal CD 3/4/8/19 and natural killer counts, mumps IgG negative, rubella IgG positive and rubeola IgG positive. Additional labe testing included a normal lymphocyte profile. PCR testing of approximately 5 scabs from the patient were positive for Oka strain of VZV. The patietn subsequently recovered without complication.A varicella IgG following the illness was positive. Published information indicated that he patient was disabeld as a result of a drowning accident in early childhood. At the time of admission to the pediatric extended care facility, he tested VZV seronegative and was vaccinated. Fifteen days later, her developed severe (>500 lesions), febrile varicella, VZV PCR and sequence analysis revealed the Oka vaccine the cause. Follow up fromthe lliterature article stated that the lesions crusted 11 days after reash onset. The patietn remained stable throughout, with no signs of sepsis. The patietn was negative for IgM antibodies. The physician also reported that two other patients who were residents of the same long-term care facility developed varicella and a rash after being vaccianted with VARIVAX (WAES# 0403USA01680), and developed varicella through secondary transmission (WAES# 0403USA01097). No further information is available.