Age: 17.0
Sex: F
Vaccine: RAB
Symptoms: Nasoendoscopy, Oral discomfort, Rhinoplasty, Skin exfoliation, Skin test negative
Clinical narrative: I first started having the problem of "incurable dry chapped lips with skin that frequently came off" in December 2011 2 months after getting 4 rabies vaccination shots due to getting nipped by a dog while on vacation with friends. My doctor recommended I get the rabies vaccination shots due to not being able to locate the dog which bit me and broke skin. I went to Hospital in for the rabies vaccination shots but they sent me to their other facility. I had the shots and at the time I felt normal and fine and this was in October 2011. Within 2 months, now December 2011, I started having a problem with incurably dry chapped lips. I would use lip balms but nothing helped the skin on my lips return to normal. At the time I did not think much of the problem because chapped lips is a somewhat normal occurrence in December even though I had never in my life had chapped lips and my skin was always oily and moisturized. I attributed my new chapped lips to having had an open nose rhinoplasty in July 2011 and I thought maybe postoperative swelling was the reason this winter I now had chapped lips & I was told that the swelling from the nose surgery could take up to 1 year to heal so I was not concerned. My dry chapped lips continued even in the summer, so I decided to consult a dermatologist I'd seen in the past. He prescribed me an ointment which did not help. Because he seemed generally unconcerned with my dry lips & my adversity to dermatologists due to acne issues in the past, I did not return. I also had problems with thick paste-like "mucus" in the back of my throat. I consulted an ENT who advised me to avoid histamine foods and advised me to try a throat spray "entertainer's secret". The spray helped somewhat with my throat mucus but it did not address the root of the problem which I was still having. I attributed this thick throat mucus problem to the open nose rhinoplasty from July 2011 as well. I then went for a general physical with my General practitioner. I told her about the problem I had had with my lips and she recommended I see another ENT but I could not see Dr. because he did not take my insurance. Around November 2016 my lip problem rose to the level of disfigurement. In school I would hide from students and the teacher because I was embarrassed of how my lips looked. The skin was completely dry and peeling, and lip balm was no longer hiding the problem as it had been from 2011 to the rest of 2016. I decided I could no longer keep my lip problem at bay using lip balms so I tried another dermatologist. She prescribed me hydrocortisone cream and mupirocin. The hydrocortisone helped my lips somewhat but as soon as I stopped using it the problem returned. I went to an ENT to see if my problem was due to having the open nose rhinoplasty in 2011 and I saw ENT who took a culture of my nose and the culture came back positive for staph. He prescribed me antibiotics amoxicillin clav for 3 weeks. The antibiotics seemed to clear up the cloudy mucus Dr. saw when taking a nasal endoscopy but nothing was helping my lips and I was starting to develop other oral problems such as mouth ulcers, tongue "ulcers", tongue bumps, general mouth discomfort and dryness, and the skin on my inner lip had an odd appearance. During a follow up appointment with Dr. he told me he thought my nasal problems were unrelated to my lip problem and at looking at my lips he postulated I might have Pemphigus Vulgaris but explained this is not his area of expertise and really had no idea what my problem was as it was rare and unfamiliar. Because Dr. thought my nasal problems were not related to my lip problems I started thinking back to 2011 and the major events which occurred in that year which was when I first started having this problem and I starting thinking about the rabies vaccinations I had in October 2011 and how my lip problems first started in December 2011. I was convinced that my lip problem had to have been a reaction or immunological reaction to the 4 rabies vaccination shots and I postulated I must have more unknown problems than simply my dry lips (exfoliative cheilitis). I went to another dermatologist in part about my lip problem and also for a yeast problem post antibiotics and she suggested I try a patch test and allergy testing. I went to ENT for a food allergen test, environmental allergen test, and week long patch test all of which came back completely negative. I decided to go to my general dentist and tell her about my issue who was very concerned and sent me to the Oral & Maxillofacial surgeon who was also confused by my problem and he recommended I see an oral medicine doctor who specializes in rare oral conditions which dermatologists do not cover. I saw Dr. on Wednesday May 31 and he had to do more research into what my oral problem was. He later diagnosed me as having exfoliative cheilitis and he treated me for 3 weeks with clobetasol ointment. He now has me trying triamcinolone ointment to treat the exfoliative cheilitis. My other oral problems which started occurring in June 2017 are a work in progress as the most distressing problem is the exfoliative cheilitis which sometimes gets to the level of a facial lip deformity & at its worse also prohibits my ability to speak (the letters p, b, m, n, f) and greatly interferes with my ability to eat and drink which has led to severe dehydration and lack of food intake which I considered going to the emergency room for but decided against it due to medical expenses which would occur. I am currently seeing the Oral Medicine Dr. I also believe I could have got an autoimmune disorder triggered by having the rabies vaccination shots so I saw a rheumatologist who has recently tested me for Sjogren's syndrome due to my symptoms and I am waiting on blood work results from him. I am convinced all of my problems have stemmed from having those rabies vaccination shots because my problem first slowly started less than 2-3 months from having those shots.