Age: 32.0
Sex: F
Vaccine: MMR, MMR
Symptoms: Pruritus, Rash papular
Clinical narrative: Information has been received from a health professional concerning a 32 year old female pt with a latex allergy and insomnia, hypertension, shaking, anxiety and a low rubella level who on 12/30/2002 was vaccinated SC in the left arm with a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (lot #643832/0857M). On approx 12/30/2002 the pt also received tuberculin purified protein derivative (manufacturer unknown) (reported as "PPD"). Concomitant medications included atenolol (TENORMIN) daily, rabeprazole sodium (ACIPHEX) daily, zolpidem tartrate (AMBIEN) 10 mg 1 Q HS, sertraline hydrochloride (ZOLOFT) 25 mg daily, calcium polycarbophil (FiberCon) and hormonal contraceptives (unspecified) (reported as "BCP's"). The pt was not ill at the time of vaccination. It was reported that the pt was required by her employer to receive the vaccination because her Rubella level was low. On 01/02/2003 the pt came in to employee health to have the PPD read and complained of soreness at the injection site. Upon examination there was found to be a 5" long x 3" wide (also reported as "knot the size of a half dollar") warm, red welt and a "somewhat raised area on the lower 2/3 of the left deltoid." Pt was instructed to apply cool compress, take ibuprofen 400-600 mg tid prn, and use a topical anti-itch cream and to follow up on 01/06/2003 if no improvement. Range of motion to left arm was reported as being good. At the time of the office visit the pt's temperature was 98 degrees F, pulse was 78 and respirations were 16. On 01/10/2003 the pt was seen "by her own MD" for re-evaluation of medications. It is reported that the pt was working on exercise and weight loss. It was reported that the pt lost 26 pounds since September on a diet. Exam findings included HEENT WNL, neck supple without adenopathy, chest was CTA, hear normal S1 S2, abdomen soft and NT, no masses palpable, no rebound, no guarding, positive femoral pulses and positive bowel sounds. At that time the doctor recommended discontinuing the Tenormin and the pt was instructed to monitor her BP twice weekly. If her BP remained less than 135/85, no further antihypertensive therapy needed. It was recommended that the the pt continue to work on diet and exercise. Pt's weight was reported as 162.8 pounds, BP was 100/72. On 01/15/2003 the pt returned to her doctor's office with complaints of a rash over most of the body, primarily on the arms, small amount on her legs with itching. The rash was described as "red blotches, fine sandpaper-type." Fatigue, weakness and muscle soreness in hips and back area was also reported. The pt denied fever and any change in her hygiene or laundry products. The physician's findings included a diffuse, papular rash, somewhat hyperpigmented in appearance, primarily on forearms, upper arms and a small amount on the legs. The pt's weight was reported as 163 pounds, temperature was 98.6, BP was 110/80. The pt saw the family physician again on 01/17/2003 and was given a prednisone taper starting at 60 mg and tapered over 9 days. The pt reported that the rash had worsened and that she had a temperature since last being seen on 01/15/2003. The temperature was reported as 100.4 degrees on the evening of 01/16/2003 and 98.6 degrees and 100.2 degrees on 01/17/2003. It was reported that the pt had a diffuse erythematous rash on the exremities with positive excoriation. The rash was described as being somewhat "characteristic of folliculitis." The pt was instructed to take erythromycin 500 mg bid and to follow up if the symptoms persisted or worsened. The pt complained of some "GI upset" but felt much better in several days and there was less rash, fatigue and soreness. The rash started to return and the pt was seen by the family physician again on 01/27/2003. The pt was given a triamcinolone acetonide (KENALOG) injection. On 01/28/2003, the pt was seen by a dermatologist who diagnosed a hypersensitivity to the measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation). The dermatologist gave the pt a "salve" for the rash. On 01/31/2003 the pt was seen in employee health and stated she had seen her own MD and a dermatologist. She did not miss any work although she did not work extra as much due to her "feeling ill". As of 02/10/2003, it was reported that the pt was "still breaking out in various parts of her body" and wondered if it was work related or a latex allergy. On 02/12/2003 the pt was seen in employee health and stated at no time had specific joint pain or swelling. The pt reported "overall" being better but was still tired and was having difficulty sleeping because of the muscle ache. The rash was much less at that time. On exam it was noted that the pt had a fair complexion, was alert and oriented and very pleasant. The pt reported that she had an "erythema flush" over her sternum that is not related. She still had some small raised areas on her arms and legs but they are "not felt." She still had "one hive on the left abdomen, larger than the rash" and continued with some itching of "intrigenous" areas. HEENT negative, some erythema and irregular patches under her nostrils, TM negative, throat negative, chest clear, no rubs or murmur, no nodes, abdomen soft, no tenderness of the liver or spleen. Pt was able to touch toes and neuro was negative. Pt described muscles as the upper gluteals that were sore. It was reported that vital signs were not taken but the pt "felt slight febrile" and pulse was about 80. The pt followed up with employee health on 03/12/2003 as a "walk in." She had increase of rash in arm and antecubital fossa, which was itching, red and blotching. Reported going under tanning bed to go on vacation. Pt was asking about medications Zoloft and Aciphex which can cause photosensitivity according to the "PDR". It was reported that the redness was diffuse over back, face and dorsal arms with slight dry skin. It was reported that a photosensitivity reaction was suspected. Labs from 10/23/2002 included a rubella IgG titer 8.9 IU/mL, Hepatitis B surface Ab > 2000 and rubeola IgG Ab 1.04. Labs done on 02/12/2003 included a SED rate of 5; a CBC, which was normal except for eosinophils of 0.9, and a hepatic function panel which was all normal. It was reported that the pt recovered. Additional info is not expected.