Age: 40.0
Sex: M
Vaccine: PPV
Symptoms: Hyperhidrosis, Lymphadenopathy, Malaise, Monocytosis, Neutropenia
Clinical narrative: Information has been received from a physician via a published literature article concerning a 40 year old male with Type II diabetes mellitus, latent tuberculosis infection and no known allergies. On an unspecified date, the patient was vaccinated with Pneumococcal 23v polysaccharide vaccine. Concomitant therapy included insulin. Subsequently, the patient developed fever, chills, rigors, profuse perspiration, sharp constant headaches, general malaise, 1 to 2 cm bilateral inguinal lymph nodes, aspartate aminotransferase levels of 120, alanine aminotransferase level was 94 and lactate dehydrogenase levels was elevated at 890. At the time of this report the patient was recovering from the events. The literature article reads as follows a 40 year old man with a history of type II diabetes mellitus and completion of 9 months Isoniazid treatment for latent tuberculosis infection in 1997 was admitted to the hospital for evaluation of fever 2 days after receiving an injection of Pneumococcal 23v polysaccharide vaccine. He reported fever to 39C on the morning after receiving the vaccine. In addition, he experienced chills, rigors, and profuse perspiration but no erythema, induration, or pain at the injection site. Two days after the onset of fever, he complained of sharp constant headaches and general malaise. Review of systems was negative for nausea, vomiting, sore throat, diarrhea, cough, chest pain, shortness of breath, Dysuria or resent weight loss. He was subsequently transferred to the hospital for evaluation of persistent fever. At the time of transfer, he was febrile to 39.9C with a blood pressure of 126/67 mmHg, pulse rate of 96 and respiratory rate of 18. The physical examination was remarkable only for palpable, mobile, 1 to 2cm bilateral inguinal lymph nodes. Results of laboratory studies were notable for a white blood cell count of 5800 (47% neutrophils, 34% lymphocytes, 19% monocytes, and 0.2% eosinophils). Aspartate aminotransferase level was 120 (normal 11-39) and alanine aminotransferase level was 94 (normal 11-35). The lactate dehydrogenase level was also elevated at 890 (normal 100-225). Urinary antigen test for Legionella was negative. A monospot test performed one week after presentation was negative. Non contrast head CT scan and lumbar puncture result were within normal limits. Findings of chest X ray, blood and urine cultures and chest abdomen pelvis computed tomography with contrast were normal. The patient was not given antibiotics. Transthoracic echocardiography and hepatitis serology test findings were normal. Fine needle aspiration of the patients right inguinal lymph node showed reactive lymphocytes and was negative for acid fast bacilli. A serologic test for human immunodeficiency virus was negative. After transfer, the patient continued to be intermittently febrile with temperature ranging between 38.1 and 40C. Nine days after the pneumococcal vaccine, the patient experienced spontaneous defervescence. The monocytosis, transaminitis and elevated lactate dehydrogenase values all returned to normal. The patient was discharged on the following day and remains well. No further information is available. A copy of the published literature article is attached as further documentation of the patient's experience.