Age: 14.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Ultrasound scan
Clinical narrative: Excessive fatigue, muscle weakness, muscle pain, joint pain, dizziness, severe headaches, severe chest pain, shortness of breath, nausea, rash, tingling and numbness in hands and feet, partial paralysis, partial loss of vision, seizures, and transient ischemic attacks.  12/8/2008 Neurology consult received for DOS 11/12/2008 with DX:  Seizure Disorder/ Complex partial Epilepsy Intractable-Status: persistant. Migraine Intractable-persistant. Mitral Valve Prolapse-persistant.  Lumbar sprain and strain-improved. Pt presented with multiple worsening sx which began 11/2007 with headaches, muscle fatigue, hair loss, itchy skin rashes, blurred vision, high pitched ear ringing, dizziness, chest pain with shortness of breath (cardiologist found chest wall and pericardial inflammation), rapid heartbeat, easy bruising, cold extremities, nausea with poor appetite, irregular meses with cramps, muscular pain of the calves and upper extremities, muscle weakness all over, joint stiffness and pain, tremors, Bell's Palsy, shuffling gait with difficulty walking, tingling, burning and numbness of the R lower & upper extremities and face. PE (+) for lower extremity swellingfacial hypersensitivity, facial dissymmetry, skin hypersensitivity to touch. Pt recently (10/29/08) had episode of throbbing frontal H/A with R-sided weakness and facial pain, drooping and numbness.  Seen in ER. On a seperate occasion the next week pt had a jerking episode which began as a fine tremor with unresponsiveness and hypotonia.  Episodes started in ~ 4/2008 occuring several times/week, now increased frequency. Pt drools and mumbles during episodes and hears high pitched sqeals. School performance has droppped due to decreased concentration and no longer able to participate in sports.   01/16/2009 MR received from PCP 11/29/07-10/30/2008.  Seen for sick visit 11/29/07for c/o sore throat, exposed to strep(Rapid strep (-)) and yeast infection x 2 months. Dx: Vaginitis.  HPV#1 given.  Returned 2/29/08 with c/o L shoulder pain and popping, fever, sore throat and new onset yeast infection. Tx Diflucan and Z-pack. No dx noted. Concern for body image distortion.  Referred to psych.  HPV#2. Returned 6/27/08 with c/o irregular menses x 6 months with heavy bleeding at start and cramping. R shoulder crepitus popping on exam.  Paresthesias in arms noted. DX:  Paresthesias.  HPV#3. Started on OCPs. Returned 9/15/08 with c/o multiple episodes of sharp L sided chest pain with SOB.  Seen in ER x 3. Heart rate fluctuations from 70-166. Tx with Ativan, Xopenex.  PE (+) for fatigue, otherwise WNL.  DX:  Chest pain.  Dyspnea.  Sent for Echo a US of GB. Returned 10/30/08 with c/o pain after sneezing with numbness and weakness R side w/ paralysis of R side of face one night prior.  No eveidence of BP on exam. DX:  MVP.   Sent for Head CT for H/A and Tremors 11/9/08. .   2/2/09 MR received from cardiology, rheumatology and neurology consults.  Cadiology visit 10/1/08 to eval severe, debilitating chest pain x 1 month. Previous w/u (-). Exam WNL. No dx made.  Rheumatology visit 11/10/08 for eval of generalized fatigue, muscle fatigue, body tremors, dizziness as well as recent onset of blurry vision of the R eye with facial droopiness. Sx started shortly after 1st dose of Gardasil 12/1/07. Hx as above. Has developed rashes which have been unresolved by any tx. Missed > 30 days of school. Intermiitent blurry vision, chest pains, weakness, joint pain and difficulty focusing. PE (+) for shoulder crepitus, tight iliotibial bands. Pt reports hair loss. No dx given.  unlikely rheumatologic.  Neurology visit 12/24/08 for eval of above sx as well as intermittent hiccups, and R hemi-dysthesias. Spells are suggestive of seizures. Encouraged to taper off medications and return for video EEG as needed. No dx given.