Age: 53.0
Sex: F
Vaccine: PPV
Symptoms: Impaired work ability, Injection site erythema, Injection site pain, Injection site swelling, Methicillin-resistant staphylococcal aureus test negative
Clinical narrative: Information has been received from a health professional and hospital record concerning a 53 year old female inspector with vertigo, chronic obstructive pulmonary disease, allergic rhintiis, hyperlipidemia, hypertension, candidiasis and drug hypersensitivity to codeine, chronic Meniere's disease and he was a chronic smoker who smoked half to one pack a day. She denied any use of alcohol and social drug. On 26-MAR-2008 at 02:00 PM he was vaccinated IM into left buttock area with a first dose of Pneumovax 23 (lot # 658451/0963U). Concomitant therapy included aspirin, ADVAIR, NASONEX, montelukast sodium (MSD), MAXZIDE, DIAZEPAM, LIPITOR, KLONOPIN and atenolol. On 28-MAR-2008 at 08:00 AM, forty eight hours after vaccination the patient started noticing increasing pain, redness, swelling of the left buttock, associated with fever, chills and body aches. She was seen in the clinic and was started on LEVAQUIN 750 mg oral which did not really help in terms of the redness and swelling. She was presented to the emergency room (ER) complaining of increasing redness and pain. She was admitted to the hospital on 30-MAR-2008 and started on empiric intravenous (IV) VANCOMYCIN for possible methicillin resistant staphylococcus species (MRSA). Infectious disease was consulted. She had blood cultures drawn and were negative for any bacteria. The MRSA screen also was negative. The patient eventually was switched to IV ANCEF and her redness in her left buttock had markedly improved. The final diagnosis was erysipelas. The patient still had some pain especially with palpation around the area but certainly her symptoms had been markedly improved. During her stay in the hospital she had bouts of shortness of breath. She was referred to the pulmonary service and was diagnosed as having an acute exacerbation of chronic obstructive pulmonary disease (COPD). She had been doing well with her respiratory medication which included DUONEB and also after being started on IV SOLU-MEDROL. She was on long-acting bronchodilators with steroids, along with montelukast sodium (MSD) and short acting bronchodilators. The patient however, developed steroid-induced hyperglycemia during her hospital stay and as the steroids had been tapered, her sugars returned to baseline normal readings. Her discharge diagnoses included: Left buttock erysipelas, Chronic obstructive pulmonary disease, Hyperglycemia which is steroid and Subclinical hyperthyroidism with normal T3, T4, and free thyromxine levels. She was doing well and was discharged to home on 03-APR-2008. Her activity will be as tolerated except that she had been instructed to stay off her feet since she spends a large amount of time standing at work as a bag screener. She got clearance from her primary care physician as to when she was to able to return to work full time. Discharge medications included: proventil metered, fluticasone propionate (+) salmeterol xinafoate, montelukast sodium (MSD0, atorvastatin calcium ad hydrochlorothiazide (+) triamterene. She also got prescription for levofloxacin to be taken daily at home that she would continue to use after discharge. Other medications are: Mometasone furoate, aspirin, tapering doses of prednisone for two weeks and albuterol sulfate (+) ipratropium bromide nebulized solutions to be used with her nebulizer. Followup will be with physician within the next 5 to 7 days and also she will undergo pulmonary function testing in about one or two weeks. On an unspecified date the patient recovered from left buttock erysipelas. The outcome for worsening COPD, hyperglyemia, hyperthyroidism, and erysipelas were not reported. Additional information was received from the physician's nurse via phone call. The patient did not have a culture of the left buttock as it was closed and not draining. No additional information is expected. All medical records will be provided upon request.