Age: 39.0
Sex: M
Vaccine: TYP
Symptoms: Red blood cell sedimentation rate normal, Sensory loss, Thyroxine free normal, Vestibular function test normal, White blood cell count normal
Clinical narrative: 41 year old male who reported no problems with his health or prior immunizations until re received the typhoid vaccine on Sat, 5 Feb 2005. He fulfilled his requirements for his drill weekend, although he noted a "wicked" headache on Sun that eased and subsided by Wednesday. He also noted a low grade fever. He did not note any arm soreness or redness and attributed the headache and fever as a normal response to the vaccination. On Sat 12 Feb he noticed dysmetria of his left lower extremity and symptoms worsened to include his left arm. On Mon he sought medical care and reports a positive neuro exam to included decrease sensation, problems with balance and increase reflexes. A MRI revealed 2 small plaques. He was started on steroids and reports a full recovery of all neuro functions by week #3. Subsequent MRI's did not identify any further lesions and he stated he remains asymptomatic. He is however, continuing interferon treatments. He stated he was evaluated at a clinic and they told him that they suspected ADEM and that an evaluation is thinking early MS. He stated he had received oral typhoid in the past with no problems and that he has not received any vaccines since Feb 05. Head pain start: 02/06/2005 End: 02/08/2005, Gait Abnormal Start: 02/12/2005 End: 03/2005, Weakness Start: 02/13/2005 End: 03/2005. Left arm.  04/12/2007 MR received for a single OV of 6/27/2005 for c/o fever, chills, myalgias, and headache which began w/in a few days of receiving his typhoid vax.  Several days later he c/o developing weakness and dysmetria.  Pt. reports that initial PE showed some dysmetria, of upper left  and lower limbs, as well as some clonus and imbalance.  Txd with solumedrol with improvement of physical symptoms.  However some word-finding difficulty remained.  PE: WNL with minimal weakness in the left interossei and ankle dorsiflexors and muslce stretch reflexes are mildly brisk.  Impression:  Clinically isolated CNS inflammatory/demyelinating syndrome, post-vaccination.  Avonex therapy.  04/19/2007 MR received from MS clinic with several OVs from 9/19/2005 to 10/30/2006.  Also included were H&P and D/C Summary from initial hopitalization for AE in 2/2005. H&P dated 02/14/2005 for c/o incoordination, ataxia, and myoclonic jerks x 36 hours.  Myoclonic jerking was noted in the L leg and L arm with associated arm heaviness.   PE showed myoclonic jerking with purposeful movement of the LLE. Biceps DTR 1+.  3+ in quadriceps and  Achilles with myoclonus on the Left. Wavers with Rhomberg, but able to correct self. Wide-based unsteady gait.Slow finger-to-nose on left. Decreased vibratory sensation left foot, otherwise WNL. D/C next day.  DX: MS. F/Us with DX of RRMS. Tx'd with Avonex. No new codes. 04/23/2007 MR received from military facility for 2 OV dated 12/13/2006 and 12/14/2006 for c/o adverse rxn. to Typhoid vax given 2/2005. HPI as above with initial findings suggesting possible MS.  Neurology consult with normal findings. Final DX:  Clinically isolated demyelinating event.