Age: 13.0
Sex: M
Vaccine: MNQ
Symptoms: Pharyngeal erythema, Rales, Respiratory rate increased, Rheumatoid factor negative, Sensation of foreign body
Clinical narrative: Monday March 2nd 1930: Minimal hives noted t/o upper body (not on face) BENADRYL 25mg given. 2100: Swelling and redness of feet. 2300: Slight increase in hives noted to trunk. Tuesday March 3rd 0330: Large amount of hives noted to abdomen/chest. C/O feeling a "lump in throat" and "feeling funny when swallows". No work of breathing or abnormal lung sounds noted. 0830: C/O neck stiffness, minimal hives and mild lip swelling noted. Seen at MD's office. Started on Prednisone 40mg in am and 20mg in pm and ATARAX q 8 hours and EPIPEN prn. Wednesday March 4th No symptoms. Thursday March 5th 0615: Awoke with swelling of lips, eyes and face. C/O neck stiffness and dizziness (no rash). 0730: Seen at Urgent Care and given ZYRTEC 10mg and Prednisone 60mg then went home. 0950: C/O shortness of breath and swelling of his hands. 1030: Seen at MD's office. Increased shortness of breath and work of breathing noted. O2 sat 94% RR 26 started on 2L O2 via mask, O2 sat increased to 98%. By 1100 increased work of breathing and respiratory rate noted. EPIPEN injection given in MD's office. Within 1-2 minutes notable improvement in breathing. 1120: Transferred via ambulance to Hospital. Throughout the day notable shortness of breath and difficulty speaking in complete sentences. Started on PEPCID 40mg bid, ZYRTEC 10mg bid, Prednisone 30mg bid, Albuterol tx prn. Later changed to XOPENEX d/t persistent tachycardia after Albuterol. O2 sat decreased to 90% and RR increased to 36 while sleeping. Albuterol tx given and crackles t/o after tx. Placed on 2L O2 per nasal cannula. RR remained 27-36 t/o night while sleeping. Friday March 6th and Saturday March 7th Continues with shortness of breath t/o the day and O2 sat down to 90% and RR remained 24-36 while sleeping with notable work of breathing. Required O2 t/o Friday night. Slight swelling under chin and in jowl area noted with extreme flushing to cheeks. Dr wanted to d/c home Saturday afternoon, I suggested to keep him overnight again to make sure he did not need O2 t/o the night. No O2 needed however he did continue with slight elevated RR at 24-27 and O2 sat 93-96% and shortness of breath noted while speaking. Sunday March 8th D/C'd home from hospital. Last dose of 7 day regimen of Prednisone given evening after d/c home. Shortness of breath noted while speaking, O2 Sat 94% t/o the day. RR 24-36 and O2 sat 88%-96% while asleep. Crackles t/o RUL and fine crackles in bilat bases. Monday March 9th Occasional shortness of breath noted. F/up at MD's office. Tuesday March 10th 0730: Fine crackles noted to bilat bases, no shortness of breath noted. XOPENEX inhaler given. 1420: Called from school c/o shortness of breath and gasping. Denied any feeling of throat closing or rash. XOPENEX inhaler given and over time symptoms improved. Evaluated at orthodontics office.....no signs of allergy to braces. Wednesday March 11th Very time c/o feeling dizzy, chills, low grade temp. Thursday March 12th Tired, cough, sore throat, low grade temp, body aches, slight shortness of breath. Friday March 13th Red enlarged tonsils with white pockets noted to right side, temp elevated to 102, chills, cough, body aches, (R) ear pain. Do with strep throat (+ Strep Screen), bilateral ear infection, pink eye. Rx'd Amoxicillin, and OCUFLOX gtts. Saturday March 14th Temp 99-102, tired, achy joints, muscles cramping in arms and hands. Sunday March 15th No fever. Tuesday March 24th Seen by Peds allergist. Does not think reaction was due to any food that was ingested, anything in the environment or to the braces. However, would not completely rule out the cause being secondary to the meningococcal vaccine, an autoimmune problem or a virus. Labs drawn (ANA, Rheumatoid Factor, CBC, Aldolase)...all WNL. As of 4/8 achy joints/muscles and flushing of cheeks and under chin persist.