Age: 1.3
Sex: M
Vaccine: MMRV, MMRV
Symptoms: Blood culture negative, Body temperature increased, Coxsackie viral infection, Culture stool, Dermatitis
Clinical narrative: Information has been received from a physician concerning a male who was vaccinated with a 0.5ml dose of ProQuad (Lot # 656720/0168U). The patient experienced a severe, non specific, rash over his entire body after receiving ProQuad. The patient was hospitalized, with length of stay unknown. At the time of reporting the patient was recovering. Follow up information has been received from a nurse practitioner concerning a 16 month old, developmentally appropriate male. The patient had no pre-existing allergies or birth defects, and a history of loose stools, yeast infection, otitis media and ear infections. Family history was positive for asthma. The patient was experiencing bi-lateral otitis media at the time he was vaccinated into the left anterior thigh on 02 APR 2007 at approximately 10:45 - 11:00AM, with a first dose, 0.5 ml, of ProQuad (Lot # 656720/0168U). On the same day, the patient was started on Augmentin for 10 days, for the treatment of bilateral otitis media (OM). The patient was seen by the pediatrician on 12 APR 2007 subsequent to developing a rash, which started as 20 red spots, while at daycare that same day. The patient presented, with papules on hands and feet, and ulcers in his mouth and was subsequently diagnosed with Coxsackie virus. The patient had vomited once. During the course of that same visit the patient was given an "antifungal" for a yeast infection. On 13 APR 2007 the patient returned to the pediatrician's office where he presented with erythematous papules with coalescing plaques to the elbow and behind the ears, and diaper area. The rash, which had spread diffusely and covered his entire body, was a macular, non vesicular, non pustular, erythematous, blanchable rash. The patient also presented with ulcers resembling Koplik spots on the buccal mucosa, back of throat. The mother denied that the patient experienced any episodes of apnea, troubling breathing or swallowing. The patient's temperature was 99.3. No other symptoms were present. The Health Department was notified of rash. On the afternoon of 13 APR 2007 the patient's mother took the patient to the emergency department (ED). The patient presented with fever, itching, and an erythematous blanchable rash, diffuse over this entire body, which was non vesicular, or non pustular in nature, and of sudden onset. The rash had progressed over his entire body since having been seen the previous evening by his pediatrician and diagnosed with Coxsackie. The ED physical examination was essentially unremarkable. The patient's pulse rate was 128, and his respiratory rate 24. Medications at that time included Spectazole, Augmentin, and vitamin drops. The patient had started daycare two months prior, and since that time has lost weight and decreased his diaper size from five to three. The mother reported that the patient has multiple loose stools daily, as well as occasional fevers. It was also noted that no one else at the daycare had a rash of this nature. The differential diagnosis at that time included, but was not limited to hand, foot and mouth disease, allergic reaction, contact dermatitis, ectopic dermatitis, medication reaction. fungal infection and measles. Blood and urine samples were collected for an unspecified study. Diagnostic tests included ABG Pulse Oximetry, X-ray, and EKG (other). The clinical impression at discharge was diffuse pruritic rash. On 13 APR 2007, after having been seen on consultation by a physician on staff at local pediatric hospital, the patient was transferred in stable condition to that same pediatric facility. It was recommended the patient be admitted with plans to undergo a dermatology consultation the following day. The following labs were obtained: Comprehensive Metabolic Panel (CMP), BCX and stool for ova and parasites (O & P), culture, rotavirus (Rota) and clostridium difficile (C Diff). The results of the following lab tests, collected 13 APR 2007, were all within normal limits: Random Glucose, BUN, Creatinine, Sodium, Potassium, Chloride, CO2, ANGP, AST, ALT, ALK, Total Bilirubin, Calcium, ALBS, Total Protein, WBC, RBC, HGB, MCV, MCH, MCHC, RDW, PLT, and MPV, HCT was low at 32.9 %. Differential results were all within normal limits, with the exception of ABS Neutrophils at 0.8K/UL, and ABS Lymphocytes at 7.1K/UL. On 13 APR 2007, a non aerobic blood culture specimen was obtained, which showed no growth after five days. On 14 APR 2007 a urinalysis was obtained, of which the results was normal, with the exception of trace leukocytes noted. Urine special studies test results were positive for reducing substances. Therapy with Augmentin, started on approximately 03 APR 2007, was stopped on an undisclosed date, and Rocephin 365 mg, intravenously one dose, was given in its place. Therapy with ceftriaxone sodium was changed to Omnicef at the time of discharge. The patient was treated with prednisone for five days. At the time of reporting the patient was considered recovered, with the date of the recovery reported as "approximately two to three weeks". There were no adverse events following prior vaccinations. No further information is expected. All medical records are available upon request.