Age: 4.0
Sex: M
Vaccine: MMR
Symptoms: Brain stem syndrome, CSF test abnormal, Delirium, Demyelination, Encephalitis
Clinical narrative: Pt with fever, dx'd with acute demyelinating encephalomyelitis. Follow up on 04/21/2001: "Patient is at home getting physical therapy and is re-cooperating.  On 12/01, patient had MMR vaccination.  A few days later, patient started vomiting which eventually lead to severe headaches and fever.  On 12/16, patient had a CT scan of the head and was found to have a sinus infection, although he had no symptoms of a cold.  Patient was being treated at home with oral antibiotics.  On 12/19, he woke up with slurred speech, left sided facial droop and left sided weakness.  patient was taken to the ER where IV antibiotics were started bacause of the suspicion on meningitis.  Patient was transferred and weakness subsided by that evening an an acutal spinal tap and MRI were not done until the latter part of the night.  The MRI and EEG were normal but there were white cells found in his spinal fluid.  At this point, MD's did not feel that he had full blown meningitis, but that his meninges were just beceoming irritated.  Patient's sinuses were drained surgically on 12/23 and they could not believe all the puss and fluid that was found in a little boy that didn't have any cold or upper respiratory symtpoms.  Patient also had a repeat spinal tap which showed lessening of the white cells.  Patient did start to do a little better after his sinus surgery and sent home on 12/27 on IV antibiotics to finish out his full 10 days of therapy.  On 12/29, patient was re-admitted because of headache and fevers.  His white count was 40,0000 and sed-rate was 100,000 which is a sign of infection.  Another MRI was repeated which was normal, although told abnormal in the beginning, but the questionable area got read as artifact movement.  A repeat spinal tap was done which was mildly elevated.  Patient went through another sinus sugery which did not show much infection.  At this point, they did not feel his sinuses were the root of his infection and that patient he checked out more throughly.  Patient had a bone scan, CT of the abdomen and pelvis, echocardiogram and lots of blood work.  Everything came back normal except elevated white counts and sed rate.  At this point, the doctors began thinking maybe he was having drug fevers from his antibiotics or he had an underlying condition such as rheumatoid arthritis.  He was seen by a rheumatologist who did take patients MMR immunization more seriously than anyone else would even listen to.  He said: " Maybe that MMR shot put those white cells in patients spinal fluid", but then dismissed it.  He wanted to see if patient off of the antibiotics because people can have adverse reactions and they may have been clouding patients picture.  Patient had finished his new regiment of antiobiotics (14 days after his first sinus surgery) and because maybe it was drug fever, we could now go home again.  We were told that patient was not going home with any life threatening condition.  Discharged for a second time on 01/07.  That night, we called his doctor and said that patient was walking like he was crippled.  Patient could hardly go up the steps, get on the couch, or walk for that matter.  Patient again began having fevers and was having very odd talking in his sleep.  He was screaming out about every half our in his sleep.  Saying very odd, lethargic-like stuff.  01/10, saw the rheumatologist again.  He was concerned about patient sleeping more and didn't feel that patient was exhibiting rheumatological symptoms, but was exhibiting more neurological symptoms.  He called our neurologist and got back in the picture.  The neurologist saw us on 01/11 and had to talk us into going back to the hospital.  She wanted another MRI and EEG.  After finding out that his white count and sed-rate were still rather elevated we agreed to go back to the hospital for a third time.  On 01/11/2001, patient was admitted for a 3rd time.  A repeat MRI of the brain and spine was now very abnormal.  He had inflammation of the brain, spine and swelling of his brainstem.  This was diagnosed as Acute Disseminated Encephalomyelitis.  At this point on 01/12, steroids were started so that patient could be watched a bit more closely.  After 48 hours of the steroid therapy, we were sent back up to the 6th floor.  Patient could walk much better.  He remained on the IV for 5 days and then gradually tapered to oral steroids for about 12 days.  Discharged on 01/19.  Patient began having headaches, weakness and tremors because of being tapered off the steroid.  He has been put back on the steroid and it has helped.  Patient attends physical and occupational therapy.  Patient still has a slight tremor of his hands and some weakness in his legs."