Age: 16.0
Sex: F
Vaccine: COVID19
Symptoms: Blood urine present, Cast application, Complex regional pain syndrome, Culture positive, Fatigue
Clinical narrative: 04/17/2021 The evening of the vaccine she experienced fatigue, drowsiness, aching, flu like symptoms, and just not feeling well. Symptoms resolved over 3 day weekend. Late July, she had a persistent vaginal yeast and bacterial infection. She was placed on a intervaginal antibiotic with minimal improvement. Another culture was ran and it showed only yeast so she was placed on Fluconazole oral tablet 150mg. Was instructed to take one tablet on July 19 and if no improvement take another tablet 72 hours later. When she took the Fluconazole she had drastic mood changes becoming moody and disrespectful which is unlike her. The next day she told me she began her period and I thought that explained the moodiness. Three days later, I found her holding her head and moaning. She acted as if I wasn't there. I moved her hand away from her head and asked her what was wrong and she said they are coming for me. I took her to the ER and they monitored her for 12 hours. I later learned that she was in a medication induced Lupus state with hallucinations. On August 11, she went to taekwondo for the first time since pandemic. When she got in the car she was complaining of wrist pain. Went home and iced wrist. Pain was unrelenting so I took her to pediatric urgent care. X-ray revealed nothing and she was placed in a removable wrist splint. Tylenol and Motrin didn't help pain. Returned to pediatric urgent care and another x-ray revealed nothing. She was referred to Ortho the following day. Ortho put a soft cast on her wrist and took another x-ray which was also negative. Told to return in a couple weeks. Pain was still unrelenting and missed large amounts of school. Called one day from school saying that she felt blistering under the soft cast. Took her to ER and they removed the cast revealing many blisters. She was referred back to ortho. They placed her back into a sling. She began loosing function in her arm. Was told to return to clinic in 1 month. Continued experiencing extreme pain and was unable to get help from ER, Ortho, or pediatric urgent care. During the course of all of this the pediatrician noticed blood in her urine. She was referred to a pediatric nephrologist. Pediatrician was very concerned about her arm and referred her to Rheumatology. Rheumatologist ran a large battery of tests determining that she had medication induced Lupus and CRPS (complex regional pain syndrome). Referred her to pediatric pain clinic and it was a 7 week wait. Pain clinic was able to get us in by the next week. Pain Clinic confirmed CRPS diagnosis. She was tried on multiple medications opioids,  steroids, the whole spectrum with no relief. She called from school saying she couldn't go on. The pain clinic instructed me to take her to the ER and have them paged when we arrived. ER and Pain management gave her a large dose of anti-inflammatory meds and morphine. She also developed tremors in her arm. At the end of March the pain management doctor did a stellate ganglion nerve block. This procedure provided minimal relief, improved her mood, and helped return some use to her arm. We have also been experimenting with acupuncture. Pain and tingling began returning mid April of 2022. She will likely be scheduled for another nerve block in the near future. This Thursday, she follows up with the nephrologist again.