Age: 2.9
Sex: F
Vaccine: PPV, VARCEL
Symptoms: Bacterial infection, Dermatitis bullous, Laboratory test abnormal, Rhinorrhoea, Urinary tract infection
Clinical narrative: Information has been received from a physician cocerning an 8 year old female with ear tubes, an allergy to peanuts and diary and partial chromosone 9 deletion called 'Corlin syndrome" which is also noted to be "9Q22 to 31 deletion." According to the physician, this syndrome menifests itself with, among other things, multiple neoplasmas. The pt also has a history of Wilm's tumor which was excised. On 01/26/1999 the pt was vaccinated with the first dose of varicella vaccine and first dose of pneumococcal vaccine 23 polyvalent. Other concomitant therapy included unknown antibiotics. It was noted that the pt had resolving otitis media with a sinus infection at the time of vaccination. On 02/07/1996 the pt was vaccinated with the first dose of haemophilus B conjugate vaccine. The pt also has rhabdomyosarcoma of the abdomen, which was diagnosed in 1998 and treated with dactinomycin, Cytoxan and vincristine until November 2000. She has a number of moles which the physician stated will most likely to become cancerous in the future and she has VonWillebrand's disease and factor IX deficiency. In April 2001, the pt had a positive titer for varicella zoster virus and an absolute neutrophil count of 2254 and an IgG of 514. On 06/05/2001, it was noted that the pt received intravenous immune globulin for IgG less than 400 within the past month, May 2001. On 05/11/2001 the pt had a urinary tract infection and an absolute neutrophil count of 2132. In "early" June, 2001, reported as 06/02/2001, the pt began to develop lesions in her "diaper area." She was seen by a dermatologist, who thought the lesions resembled a "staph infection," and placed her on Keflex. The pt's temperature was 98.6 deg. F. and she had nasal discharge. The lesions continued to develop and the reporting physician saw the pt on 06/04/2001, at which time she noted thirty "generalized, red raised lesions with central vesicles containing clear fluid." They were also described as 1/2 to 1cm papules with central vesicle containing clear fluid which were located on the arms, anterior trunk and abdomen. The physician reported that there was a concentration of lesions in the pt's diaper area, but there were also generalized lesions. The pt had no fever or any other sings/symptoms. The physician did a bacterial culture of the lesions and also had several swabs of the vesicles which she would like to send for PCR analysis. The child is in public school; however, there was no known current outbreak of varicella in the school or community and the pt did not have recent exposure to chickenpox or shingles. It was reported that the pt recovered from varicella and bacterial infection. Outcome for urinary tract infection and nasal discharge was not reported. It was noted that the swab specimen from the vesicular rash was inadequate to process for PCR analysis. The physician noted htat the pt did have a bacterial infection +staph aureus. The pt has been treated and completely recovered from the rash. Follow-up info from a physician noted that on 06/04/2001, the pt developed a staph skin infection that was treated with Keflex and Bactroban. It was noted that the infection improved in 2-3 days. It was reported that the pt recovered on 06/18/2001. Additional info was received from the pt's medical records concerning a check-up the pt had on 01/25/1996, the date of the varicella vaccine. This info noted that the pt was doing much better and was active. she did not appear to be in pain anymore. There was no fever or runny nose. A few weeks prior to this date, the pt began to wak a few steps by herself. The pt was noted to have resolving otitis media with a sinus infection. She was to continue with physical, speech and occupational therapy. It was also noted that in approx. January 199, the pt had a PPD test placed on the left arm which was negative. No further info is available.