Age: 18.0
Sex: M
Vaccine: MMR, TD, YF, MMR, TD, YF
Symptoms: Eye pain, Myelitis, Optic neuritis, Sensory disturbance, Vision blurred
Clinical narrative: Information has been received from an agency (VAERS 214072) concerning an 18 year old who on 7/26/02 was vaccinated with a dose of MMR vaccine. Additional suspect therapies included vaccination on 7/26/02 with a dose yellow fever virus vaccine and a dose of TD and revious vaccination on 6/27/02 with a dose of Menomune, a dose of IPOL and a dose of hep A. Approximately 20 days after receiving yellow fever virus vaccine, TD and MMR II the pt experienced blurred vision and eye pain, which also progressed to inability to void and decreased sensation to his lower extremities. On 8/25/02 the pt was admitted to the hospital and he spent three days there. He was diagnosed with Devic's syndrome and had optic neuritis and myelitis. He improved dramatically with steroids and had outpatient rehabilitation to regain full mobility. He had no recurrences of his illness and fully recovered. Medical records were requested by the agency. No other info was provided. File to be completed.  Follow up on 05/24/04: "Follow up received reported that the pt was 19 years old at the time of vaccination, other relevant history noted as none and adverse event onset was one month after having a "common cold". On 08/14/02, 19 days post immunization he awoke with bilateral eye pain, which was not accompained by visual impairment, as well as, blurry vision bilaterally with the right worse than the left. His vision deteriorated until he could not see with his right eye. He also developed right leg numbness, right arm tingling, neck stiffness, difficulty urinating and fever. The pt saw his primary care physician on 08/25/02 and was referred to an ophthalmologist. An orbital MRI displayed bilateral retrobulbar optic neuritis. A whole spine MRI showed multiple lesions all over his spinal cord. He was admitted to the hospital on 08/25/02 by the neurology service of the hospital. Hospital lab evaluation revealed: CSF RBC7, WBC 465, LYMPHOCYTES 85%, GLUCOSE 54, PROTEIN 117, VDRL negative, oligoclonal bands negative. Lab evaluation also revealed: WBC 21, H/H 13.2.2/40, PLTS 468, RHEUMATOID FACTOR NEGATIVE, ANTIdsDNA NEGATIVE, HIV NEGATIVE, SED RATE 25, TSH NORMAL, SODIUM POTASSIUM CHLORIDE, CO2, GLUCOSE, BUN, CREATININE ALL NORMAL. AST 24, ALKALINE PHOSPHATASE 82, AND ALT 20.  Diagnostic studies revealed CXR on 08/25/02 normal, MRI on 08/25/02 showed abnormal enhancement and enlargement involving the optic nerves as well as multiple areas of abnormal signal in the spinal cord and brain stem. Initial physical examination revealed neck stiffness on forward bending and several small palpable lymph nodes in the right posterior cervical area. Pupils were 6mm on the right and 5mm on the left. Pupillary light reflex was sluggish, with APD on the right and prompt on the left. Vision 20/400 on the left and unable to count his fingers on the right. He experienced tenderness with full extraocular movements. Strength was 4+/5 of left hip flexion. He had hypesthesia and dysthesia to pinprick below the right T6 level and possible hyesthesia to pinprick below left T10. Additionally, he had gait dragging on the left side, but was able to walk on his heels and toes. He was unable to stand on either the right or left foot alone and was unable to perform tandem gait. He wastreated with IV Solu-Medrol 1000mg for 2 days. His visual symptoms improved dramatically with treatment and his visual acuity was restored almost to baseline. The pt was able to void successfully. His unsteadiness improved, but the numbness remained unchanged. The pt was discharged home on prednisone and Protonix on 08/27/02. He was seen for follow up examination on 09/18/02 and had areas of patchy light touch and pinprick sensory loss from the mid-anterior thigh and distally. The area of transition from normal to abnormal sensation was approximately 3-4cm proximal to the bilateral patella. He was placed on prednisone and azathioprine. He had a normal examination on 09/20/02.  On 11/25/02 an MRI revealed cervical and thoracic spine normal.  On 01/22/03 (reported as 2002) exam was normal. On 01/22/03 the pt physician recommended against receiving the SP vaccine. On 05/20/03 he had a normal examination and continued to taper prednisone and azathiopine. On 11/21/03 the pt was off of the prednisone and azathioprine and had a normal exam. The pt was still in the coast guard at that time. File to be completed."