Age: 19.0
Sex: F
Vaccine: HPV4, HPV4
Symptoms: Injection site pain, Lymphadenopathy, Menstruation irregular, Muscular weakness, Nuclear magnetic resonance imaging normal
Clinical narrative: Notable increase in allergic reactivity and unwellness after first shot. Shot extremely painful going in. Patient has high pain tolerance, and stated it was the most painful thing that ever happened to her. Left tonsil and lymph node in left arm swollen and painful.  After second shot anaphylactic reactions with symptoms increasing and cascading into respiratory distress, feeling heavy pressure on chest, severe digestive issues.  Muscle heaviness and dibilitating fatigue and mental fog.  Heaviness and weakness more pronounced in limbs. Symptoms exacerbated by even minor exertion. Each episode lasted longer than previous and became disabling to the point patient needed wheelchair. Could not stand up to shower, or raise arms to wash hair. Became airborne and skin reactive to strong chemical and food odors. Heart palpitations. Dizziness and faint feelings.  Intolerant of even trace amounts of citric acid, and soy lecithin. Intolerant of all fruits, all vegetables or products source from them.  Did not have menstruation for almost 2 years.  Now has heavy cycles lasting weeks.  Metallic taste in mouth. Heavy grey buildup on teeth despite no change in oral hygiene (meticulous oral hygiene). Severe skin problems on face.  All over bloating, especially in face and abdomen.  Rashes, hives, tongue swelling, painful eruptions on tongue.  Episode of tongue swelling witnessed by allergist upon accidental exposure in office to trigger.  Seen by Allergists, ENTs, Gastroenterlogists, Speech Therapist, Dietician, Screened for Asthma (negative), Multiple blood tests, and CT scans. Given protocol of multiple antihistamines, Gastrocrom, nebulizer. No effect. Seen at Neurology, various MRIs.  Seen by Allergist, and Neurologists.  Seen by PA.  Had to take medical leave from college. Acupuncture for past year. 10/22/09 and 10/23/09 Medical records received from dates 9/11/08 to 5/6/09 DX: Anaphylactic reaction, secondary to multiple food products, worse with citric acid.Presenting symptoms: Pt. with strong complex history of allergic reactions to foods, shortly having immunizations as a child food allergic reactions intensified. Pt experienced anaphylactic reaction in high school after drinking apple juice, and after exercising. Pt received vaccine during college and symptoms worsened. Received flu shot (2007) had GBS type symptoms. HPV vaccine 2007 and symptoms/reaction have increasingly worsened. Pt develops rash, hives, swelling in throat, vomiting, tongue swelling. Pt. states now anything with citric acid in it causes a reaction. Pt cannot touch door handle that someone else has touched if they have had citric acid on their hands. Reactions affect her memory, and has extreme weakness after episodes causing her to have to use a wheelchair for some time after each episode as well as noted memory loss. Impression: continue antihistamine therapy, refer to allergist. 10/23/08 F/U appt. pt. seen for increase in weakness. Pt in wheelchair with continued allergic reactions. Pt to have neurology consult and allergist consult.DX: extreme anaphylaxis with musculoskeletal weakness. 9/29/09 Allergy consults DX: Erythematous patches, rhinosinusitis, vocal cord dysfunction suspected, GERD, shortness of breath. Diagnostics/Labs ordered. 10/22/09 Allergy consults. DX: pt. sx. very difficult to ascertain and define. Neuro consult suggested. Suggest to see pt during episode. PE: WNL other than history involving multiple symptoms. Diagnostics/Labs ordered. 3/16/09 Neurology consult. DX: Unable to answer if this is a true neuromuscular weakness or whether it represents a sense of fatigue and weakness r/t the systemic illness. No evidence of neuropathy. Diagnostics/Labs ordered. 5/6/09 Allergy consult findings: vague adverse reactions, very difficult to ascertain, possible allergic, but unlikely. PE/Labs/Diagnostics all WNL.