Age: 17.0
Sex: F
Vaccine: MEN
Symptoms: Headache, Myelitis transverse, Pyrexia, Sinusitis
Clinical narrative: From initial information received on 8/11/03 from a health care professional regarding an adverse event, it was reported that a 17 year old female patient received a Menomune A/C/Y/W-135 vaccination, lot number U8448AA, administered in the left arm on 6/11/03. Reportedly sometime after the vaccination a neurologist diagnosed the patient with transverse myelitis. The patient was hospitalized, details not provided. The patient had concurrent viral illness at time of vaccination. Recovery status of the patient is currently unknown. A 15-day follow up report received 01/12/2004 adds: From additional info received on 12/11/2003 through a telephone call to the reporting facility, the fax number and responsible physician's name were provided. No other info was obtained at this time. No additional relevant info was obtained for the adverse experience: this follow-up report is not submitted to the Health Authorities. From additional info received on 12/29/2003 from a health care professional, it was reported that the pt developed a cold as well as conjunctivitis on 05/31/2002. The pt had headache and a low grade fever ranging from 99 to 100.1 degrees F 5 days after vaccination. She was seen by her physician on 06/18/2003 for cold symptoms, a possible sinus infection, headache, post-nasal drip and fever lingering for 2 1/2 weeks. On examination, her tympanic membranes were slightly retracted and she had nasal congestion and post-nasal drip. She was prescribed Z-pack (Zithromax) to take as directed for sinusitis. On 06/20/2003, the pt spoke with the physician's office and reported that she had a temperature of 102 degrees F, congestion, ringing in the ears, chest discomforrt, no appetite and headache. She denied abdominal pain. On 06/23/2003, the pt was seen in the physician's office. Her blood pressure was 100/60 and her temperature was 97.3 degrees F at the time of examination. She reported that she still felt as if she had the sinus infection and was still experiencing headache and fevers ranging between 100.4 to 101.4 degrees F axillary. She reported that she was taking Excedrin, which temporarily relieved the pain. Her cough was improved and she had really thick mucus, but at the time of the examination there was not much drainage. She denied neck pain and reported that her decreased appetite continued. On examination, the tympanic membranes were clear and the turbinates were very edematous. She was diagnosed with probable sinusitis and prescribed Ceftin 250 mg twice a day for 10 days. She was also to resume Nasonex and increase fluids. She was seen in the ER on 06/25/2004 for dysuria. She complained of urinary urgency and stated that she had experienced difficulty urinating since 06/23/2003. The suprapublic region was tender upon examination and the bladder was distended. She complained of bilateral leg weakness and a wobbly gait since 06/23/2003. She was catheterized to relieve urinary obstruction and drained 850cc of clear urine. A specimen was sent for culture and was negative for growth. At the time of examination, the pt complained of both legs feeling shaky and stiff, as well as dull, constant abdominal pain in the suprapubic area. Sensory examination was normal with intact touch and no objective paresthesias. Normal symmetrical reflexes were present and gait was normal for age. Blood work revealed anemia (HGB was low at 11.8 g/dL, HCT was low at 34%). The pt was discharged with a diagnosis of urinary retention. On 06/26/2003, the pt was seen for follow-up and catheterization and it was noted that she was very weak and shaky. The physician referred her to a neurologist and she was seen that day for evaluation and was admitted to the hospital. On admission it was noted that she had experienced bilateral mild leg weakness, urinary retention and constipation, as well as hypersensitivity of her skin and tremulousness in both arms and front chest pain since 06/23/2003. Physical examination revealed clonus of bilateral legs and hyperreflexia on bilateral upper and lower extremities (3+). There were questionable T4 levels bilaterally. She had upgoing toes bilaterally. Neurological examination revealed that there was some evidence for myelopathy. The pt was diagnosed with transverse myelititis. At the time of admission, there was taking axetil, Nasonex, Flomax, cefuroxime and Excedin as needed. She was treated with intravenous Solumedrol for 3 days at 1 gram and followed by a prednisone taper. Her symptoms improved. Gradually her headache was completely resolved and her bilateral leg weakness was improving. Her urinary retention and constipation were resolved. The pt had complained of intermittent double vision since 06/30/2003, but that had also dramatically improved by the time of discharge from the hospital. Her discharge medications included Protonix 40 mg orally once daily in the morning and prednisone 60 mg orally in the morning for 2 days, then 40 mg for 2 days, then 20 mg for 2 days then discontinue. She was to receive physical and occupational therapy 3 times a week for one month. She was seen by the neurologist on 07/08/2003 for follow-up. She had completed the prednisone taper and felt that her leg weakness was much better. Her headache had completely resolved. The urinary incontinence was also improved, but she was still having increased frequency of urine with slight hesitation while urinating. She had no constipation and had started here physical therapy recently. The clonus was still present in the left lower extremity and toes were downgoing bilaterally. She had decreased sensation to pinprick on her bilateral lower extremities up to the middle thigh area. She was again seen by the neurologist on 07/25/2003 for follow-up. At that time it was noted that she was going to improve and her strength was back to normal. She had some residual decreased sensation in the distal lower extremities and was still urinating more frequently. She stated that she felt like she had to squeeze her abdomen to express urine, but it was also improving. At that time, the pt's headaches had completely resolved. She was told that some of the spinal fluid results may be consistent with multiple sclerosis, but that it was thought that the transverse myelitis was probably secondary to getting meningococcal vaccine while the pt had a viral illness. The pt was seen again by the neurologist on 08/07/2003. At that time she was stable neurologically and had no weakness of the lower extremities. She continues to be slightly off-balanced in the morning when she got up and still complained of increased urinary frequency, which was improving. The results of the spinal fluid multiple sclerosis battery revealed an elevated myelin basic protein, but was negative for oligoclonal bands. Her IgG synthetic rate was normal. The impression was transverse myelitis most likely, rule out multiple sclerosis. An elevated myelin basic protein can be seen in both transverse myelitis as well as multiple sclerosis. The MRI of the brain and MRI of the cervical and thoracic spine did not show any lesions, which makes multiple sclerosis unlikely. There is still a possibility if the pt develops recurrent symptoms. No other info is provided. It was not reported if the pt recovered.