Age: 9.0
Sex: F
Vaccine: FLUN3, FLUN3, FLUN3
Symptoms: Neuromyelitis optica, Nuclear magnetic resonance imaging, Nuclear magnetic resonance imaging brain abnormal, Nuclear magnetic resonance imaging spinal cord abnormal, Nystagmus
Clinical narrative: A serious spontaneous report of blindness, felt weak and lightheaded has been received from a medical assistant concerning a nine-year-old female patient, subsequent to FLUMIST administration. Medical history of the patient includes prior uneventful receipt of inactivated influenza shot in the previous years. She was healthy at the time of vaccine administration. The patient was not taking any other medications at the time of the event. On 12-Oct-2010, the patient received FLUMIST. On 13-Oct-2010, the patient developed fatigue; the following day she developed loss of appetite and a dull, intermittent headache. During the next few days, the patient developed double vision, nausea, non-bilious emesis, increased urinary incontinence with a feeling of incomplete voiding, gate instability, loss of perioral sensation and medial left eye deviation. She went to the emergency department on 20-Oct-2010. Laboratory tests revealed a normal complete blood count (CBC), normal chemistry panel and normal urinalysis. A head magnetic resonance imaging (MRI) scan and an abdominal ultrasound were normal. An ophthalmologist examination revealed bi-cranial nerve palsy, an elevated nasal optic disc and the bi-visual acuity of 20/50. The patient was sent to a university emergency room (ER). On 20-Oct-2010, a lumbar puncture cerebrospinal fluid (CSF) revealed increased white blood cells (WBC) and lymphocytes 92%. The neurology department was consulted on 21-Oct-2010 and reported a left head tilt, right partial abducens gaze palsy; the temporal aspect of the right optic disc was clear; however, it was difficult to visualize the rest of the disc. Gaze-evoked nystagmus, mild left lower face droop and decreased sensation to the lower face bilaterally was also noted. The patient also was found to have bilateral dysmetria with a wide-based brisk and mildly ataxic gait and hyperreflexia. On 21-Oct-2010, an infectious disease consult was obtained. A full infectious disease work-up was negative for TB, EBV, CMV and Lyme. A DFA panel was positive for influenza B. On 21-Oct-2010, a repeat MRI scan of the brain and spine with contrast showed enhancement, thickening and abnormal intensity within the optic pathways and several cranial nerves. On 21-Oct-2010, a repeat abdominal ultrasound revealed a post-residual volume of 435 ml, so a Foley catheter was placed. On 22-Oct-2010, a repeat lumbar puncture (CSF) was negative for HSV1 and 2, enterovirus, VSV and cryptococcal antigen, with an IgG index of 0.5, WBC 16, lymphocytes 91%, monocytes assessed with acute meningoencephalitis and bilateral optic neuritis. On 22-Oct-2010, the patient was started on a five-day course of methylprednisolone for suspected acute demyelinating encephalomyelitis. From 21-Oct-2010 though 26-Oct-2010, acyclovir for herpes simplex virus (HSV) prophylaxis, 22-Oct-2010 through 27-Oct-2010 cortisone for Lyme prophylaxis and oseltamivir from 23-Oct-2010 through 28-Oct-2010 because she