Age: 0.3
Sex: M
Vaccine: DTAP, HIBV, IPV, PNC, RV5
Symptoms: Cheilitis, Chest X-ray abnormal, Culture stool negative, Culture urine negative, Culture wound positive
Clinical narrative: Information has been received from a physician concerning an 18 week old male, with allergies to a brand name diaper and (Rocephin), who on 21-JUN-2007 was vaccinated with a second oral dose of Rotateq. Concomitant vaccines administered on the same day included a second intramuscular dose of Prevnar, a second intramuscular dose of Tripedia, a second dose of ActHib and a second intramuscular dose of IPOL. It was unknown if there was an illness at the time of vaccination and no adverse events following prior vaccination. On 29-JUN-2007 the patient developed a high fever, bandemia, and a rash. The patient was admitted to the emergency room with fever and red, cracked, bleeding lips, and a rash for several days. At that time he had a decrease in activity and appetite. It was reported that because of the concern for sepsis, urinary tract infection or other bacterial infection, he was hospitalized on 30-JUN-2007. On initial evaluation, a chest-x-ray was ordered. Complete blood cell count, comprehensive metabolic panel, blood cultures x 2, stool culture, urinalysis, and urine culture were ordered. The chest x-ray showed mild bronchial wall thickening as well as mild perihilar infiltrates. A repeat x-ray on 04-JUL-2007 showed similar readings. Initial laboratory tests showed a complete blood cell count with a normal white count, and high platelets with 12% bands. The patient continued to run a fever, and subsequent complete blood cell counts were obtained, which showed elevated white blood cell counts up to 18.3 with a neutrophil predominance and mild bandemia. Initial chemistries were unremarkable. A urinalysis was unremarkable. Of note. all cultures, including blood, urine and stool did not grow out any bacteria. He did have a wound culture done from scrotal skin breakdown, which grew Enterococcus faecalis. The patient continued to run a fever for five days and had the above mentioned laboratory results as well as physical exam findings, and Kawasaki's disease was presumed. On 05-JUL-2007, he was given IV IG 3mg/kg x one. He was also started on high dose aspirin until afebrile. After starting the IV IG, he remained afebrile. The patient was monitored for 24 hours. After the IV IG had been given, he did not run any further fever. At that time, his appetite had improved and he was off all intravenous fluids, and was tolerating formula without difficulty. He was voiding and stooling without problems. It was decided that he could be discharged home with close follow-up. It was noted that a heart murmur was noted throughout his hospitalization and a subsequent echo and EKG were performed. The final readings were not available at the time of discharge on 07-JUL-2007. The discharge diagnosis was Kawasaki's disease, fever, leukocytosis, rash, and thrombocytosis. It was noted that the event was initially thought to be a (Rocephin) allergy. The patient was reported to be recovered on 05-SEP-2007. Additional information has been requested.  10/16/07 Received hospital medical records which reveal patient experienced fever, cracked lips & rash for several days w/lethargy & decreased appetite.  Admitted 6/30-7/7/07. Tx w/IVIG & high dose ASA.  Improved & d/c to home on continued low dose ASA & scheduled for f/u echocardiograms. FINAL DX: Kawasaki's disease; fever; leukocytosis; rash; thrombocytosis. 12/21/07 Reviewed vax records & VAERS database updated w/same.