Age: 1.0
Sex: M
Vaccine: VARCEL
Symptoms: Rash vesicular, Renal failure
Clinical narrative: Information has been received from a physician and a healthcare professional concerning a 14 month old male with no known allergies who is immunocompromised due to a history of neuroblastoma, chemotherapy and a posible bone marrow transplantation. (It was noted that the pt had been evaluated for a bone marrow transplant; however, it was not known if the pt actually received the transplant). On 05/18/01, the pt was vaccinated with one dose of varicella varus vaccine live in the right thigh. Concomitant therapy included Norvasc, antineoplastic and captopril. On 08/16/01 (approximately 90 days post-vaccination), the pt developed a rash at the site of injection that was noted to be a vesicular lesion and turned into verrucous with 50-100 lesions on the right outer thigh, vesicles are grouped together on erythematous base. It was noted that the pt has had several bouts of herpes zoster which was reported as chronic rash that was present since August 2001. On 01/08/02, it was noted that the most recent episodes of herpes zoster was within the past 1-2 weeks. The pt was admitted to the hospital last week, January 2002, but the physician did not know if the reason for admission was the herpes zoster. On 01/04/02, a specimen (skin biopsy) was obtained from the verrucous lesion. The lab had an isolate which was VZV by DFA. The physician noted that the treating physicians would like to submit a specimen for PCR analysis. It was unknown if they would be sending the isolate or collecting a new specimen. Upon follow-up it was reported that the pt "now" had "verrucous lesions despite acyclovir also renal insufficiency." The pt did not have a recent exposure to chickenpox or shingles. The physician noted that on 01/15/2002 a specimen was to be sent for PCR analysis. Info from a woman in the lab noted that the specimen was insufficient to process. The specimen was inadequate, negative for B-Globin, no strain ID. Info from a healthcare professional noted that the insufficient results for the specimen were not suprising because they were not sure how good the specimen was. The healthcare professional was not aware of any other specimen for this case, because at the time this was originally reported, 01/08/02, the pt's lesions were pretty well "dried up," so he did not think there would be any additional specimens. Additional info from the physician noted that the pt had renal insufficiency secondary to chemotherapeutic agents used to treat his neurolbastoma. He stated that the "renal insufficiency was not secondary to the varicella vaccine." The physician noted that the neuroblastoma was diagnosed days to weeks after the varicella virus vaccine live was administered but he "certainly did not feel there was any relationship between the administration of varicella vaccine and the diagnosis of neuroblastoma." The temporal relationship was purely coincidental. It was noted that he did not feel in any way that the neuroblastoma should be an adverse experience reported after the administration of varicella vaccine live. The physician noted that more specimens might be available from the "chronic" intermittent herpes zoster. Additional info was received on 01/31/02, from another physician who noted that this pt was presently "very ill" and would be going to the operating room that day. The pt was to have a bronchoalveolar lavage and this physician indicated that there was a concern about possible varicella zoster virus infection in this child. The physician noted that she should be in contact if there are any additional specimens to submit for PCR analysis. This physician indicated that she thought the pt was diagnosed with the neuroblastoma on the same day as the vaccination with varicella virus vaccine live. Info from a healthcare professional on 02/05/02, noted that there was another lesion specimen available from this pt to send for PCR analysis. the specimen was obtained on 01/31/02. This specimen was from a 'tissue biopsy-verrucous lesion" and it was noted that there was"plenty of tissue." This specimen grew varicella zoster virus and the presence of Oka/vaccine strain was identified from the tissue biopsy specimen. Info from a physician on 02/22/2002 noted that the pt was at home and was definitely not in the hospital. This physician was not sure what phrase of treatment the pt was in for his neuroblastoma since there was no consult at this point. The pt's renal insufficiency was determined to be an incidental finding. Additional info has been requested.  It has been determined that WAES# 0201USA00606 is a duplicate of WAES# 0303USA00964. Therefore, WAES# 0201USA00606 is being deleted from our files and the reports consolidated into WAES# 0303USA00964.