Age: 0.17
Sex: F
Vaccine: DTAPHEPBIP, RV5
Symptoms: Parenteral nutrition, Pyrexia, Rotavirus test positive, Sepsis, Sigmoidoscopy
Clinical narrative: On February 8,2017 afternoon, patient was running a low grade fever and was crying more than usual. On February 9, 2017, low grade fever was gone. I observed that patient was having frequent very watery bowel moments, soaking the cloth diaper. Patient was also having a different kind of spit up while nursing. It was a large volume and I could see she was uncomfortable. On February 10, 2017, she was still having frequent watery diarrhea. While nursing she would vomit such a large amount of milk that she was spitting my clothes, the floor and I had to run to the sink with her to finish throwing up everything. On February 10, 2017 evening, we noticed some dark circles around her eyes. When we woke up at 6-7 in the morning of February 11, 2017, patient looked so different from when we went to bed at midnight that we decided to get her to the Emergency Room. She was very skinny, would not wake up much as I was changing her diapers and her clothes. We were scared. We took her to Healthcare clinic just 20 minutes from home. They told us she was severely dehydrated. She was lethargic and had a very high heart rate. We spent about eight to ten horrible hours at the ER. The doctors could not decide where to get her admitted because the lab work, Xrays, and other tests were showing results that had them confused. She was finally admitted to the ICU. We spent about 18 hours there before they needed to bring a "more sick" patient and relocated patient in the General Pediatrics floor. She was positive to presence of rotavirus in her stool. The doctors thought it was just a usual rotavirus enteritis. At the moment of discharge, the vomiting was controlled and her stools were looking a bit better although still had a mushy aspect to them. We were allowed to go home on February 14, 2017. Unfortunately, the very next day, I woke up to see that patient was looking as dehydrated as when I first got her to the ER a few days ago. We decided to go back to the same ER. That visit to the ER was shorter but the hospitalization was the longest. Patient spent a total of 70 days, from February 15-April 26, 2017 during her second hospitalization. During that stay, she spent time in the General Pediatrics floor for about 10 days, the NICU for about 14 days, and again the GP floor for the rest of the hospitalization. She had a PICC line implanted in the right arm just before moving her to the NICU so she could get Total Parenteral Nutrition via IV while having nothing by mouth. The doctors' hypothesis was to provide nutrition while letting her gut rest in hope that it would get healed. Among other tests and procedures, the most relevant were two upper endoscopies and two sigmoidoscopies (mid-March and late April), a genetic test, one blood transfusion, IVIG administration, and a swallow test; all of them inconclusive. The genetic test provided some information but not enough that would explain this unusual long term reaction to a rotavirus vaccine. The doctors allowed us to return back home on April 26, 2017 with patient which was still on TPN with home nursing assistance and IV infusion services; her main treatment, an oral medicine Tacrolimus, an immune system suppressant, in combination with steroids. Per doctor's orders, patient has nothing by mouth since a week or two before being discharged in April. After five intense days of getting training by registered nurses on how to prepare the IV infusion (TPN and lipids) and administer IV medicines, we had to return to the ER because patient was running a 38 degrees Celsius fever. She was diagnosed with sepsis cause by a stomach bug from her own stomach. That third hospitalization was 23 days total (from April 30, 2017 to May 22, 2017). After making sure patient was free from infection in her blood, the doctors decided that to remove to the PICC line and insert a Central Venous Line in her chest (a surgical procedure) on May 5, 2017. She also received her second blood transfusion. Currently, patient is seven months old. She still has watery stools (7-8 diapers a day), sometimes there is blood on them. She depends on TPN and lipids to receive her nutrition. Since the medicines she gets to treat her symptoms affect/suppresses the immune system, she is limited to the type of activities that she can do. She cannot have milk, solid food, pureed food like a normal baby would at her age.