Age: 19.0
Sex: M
Vaccine: ANTH, ANTH, FLUX, HEP, HEPA, IPV, MMR, TYP, YF, ANTH, HEP, HEPA, MMR, VARCEL, YF
Symptoms: Hypoaesthesia, Laboratory test abnormal, Pharyngolaryngeal pain, Pyrexia, Urinary retention
Clinical narrative: Information has been received from an agency concerning a 19 year old male who on 2/2/03 was vaccinated with a second dose of MMR (second generation). Concomitant therapy on 2/2/03 included a first dose of anthrax vaccine (manufacturer unknown), a dose of yellow fever virus vaccine live (manufacturer unknown), a dose of poliovirus vaccine (manufacturer unknown), a dose of typhoid vaccine (manufacturer unknown), a dose of influenza virus vaccine (manufacturer unknown), possibly a dose of varicella virus vaccine live, a first dose of hepatitis A vaccine (inactive) (manufacturer unknown) and a second dose of hepatitis B virus vaccine (manufacturer unknown) (there was no lot #'s provided for any vaccine). ON 2/20/03, the patient received a second dose of anthrax vaccine (manufacturer unknown). On 2/22/03, it was reported that the patient was hospitalized with complaints of fever 100.4 degrees F, sore throat, headache for five days, numbness from the knees down, weakness and difficulty walking. He also had pressure on genitalia and urge to urinate. The patient was diagnosed with acute disseminated encephalomyelitis and urinary retention. The patient was treated with high dose steroids and physical therapy. The patient was discharged to another hospital on 3/1/03. It was reported that his condition regressed to an inability to walk, decrease in sensation, inability to void after being off steroid for about three to five days. He was given another course of high dose steroids for five days and IVIG for two days. The patient did improve. He was put on oral steroids for three weeks. He was discharged from the hospital on 3/19/03 with a discharge diagnosis of unspecified infectious and parasitic diseases, retention of urine and post-infectious encephalitis. It was reported that on 3/21/03, the patient stated that he still had some numbness in his feet but was otherwise greatly improved. The patient stated that he had been ill will an upper respiratory infection about mid-February and was taking amoxicillin, pseudoephedrine hydrochloride, ibuprofen, and acetaminophen at the time of the anthrax vaccination on 2/20/03. The reporter indicated that within one to two days afterwards, the symptoms of encephalitis were noted. Lab testing included a lumbar puncture (LP) done 2/23/03. The CSF results were as follows: glucose 77, protein 73, WBC 159, RBC 4, mononuc 90%, lymphs 78, monos 12. The lyme screen was negative and the blood and urine cultures showed no growth. The throat culture was negative for strep group A. Testing was performed from two samples, a CSF sample and a serum sample, both collected on the 12th day of illness onset (3/6/03). Results of the CSF included: Good IgM response by MAC-ELISA (OD ratio 9.8), negative for West Nile, St. Louis and Powassan; neutralization antibody assay not done for CSF (there is no standard for this); negative virus culture on Vero cells and TagMan PCR for yellow fever was not done. Results of the serum included: Good IgM response by MAC-ELIZA (OD ratio 9.8), negative for West Nile, St. Louis Powassan; plaque reduction neutralization test for yellow fever virus was positive at a 1:320 titer; negative virus culture on Vero cells and negative TagMan for yellow fever. Additional information has been requested.