Age: 17.0
Sex: F
Vaccine: MNQ
Symptoms: Asthenia, CSF cell count, Hypoaesthesia, Myelitis transverse, Nuclear magnetic resonance imaging brain abnormal
Clinical narrative: Eight days after immunization, patient experienced parasthesias in lower extremities that progressed to weakness and loss of bladder control over the next two days.  Diagnosed with Tranverse Myelitis at a hospital.  Treated with IV steroids and transferred to Hospital.  By September 24 she had made a near complete recovery.  Then in December of 2007, she developed new parasthesias and was evaluated by her neurologist.  MRI of the brain showed lesions consistant with Multiple Sclerosis (MS).  The previous MRI in August had been normal.  She is now undergoing treatment for MS.  1/11/08 FINAL DX: Acute transverse myelitis. Received medical records from initial hospital which reveals patient experienced sudden low back pain, bilateral leg pain, loss of bladder control, & urinary retention x 1 day with altered sensation in legs & unable to stand or walk w/o assist secondary to pain. This occured while she was on vacation.  Hospitalized 8/8-8/10/2007.  Neuro consult done & dx w/acute transvere myelitis.    3/11/08 FINAL DX: Transverse myelitis from T6 to clonus.   Reviewed hospital medical records for admission 8/10-8/14/2007 which reveal patient experienced loss of sensation in legs & trunk & was paraplegic.  Transferred from outlying hospital.  Neuro consult done.  Tx w/steroids & improved.  D/C to home on tapering steroids to f/u as outpatient.    1/11/08 Reviewed rheumatology office notes which reveal patient initially evaluated 8/15/07 s/p (+) ANA & recent transverse myelitis.  Had developed HA 2 wks prior & sudden severe constant sharp pain in her lower back w/tingling in both legs.  Seen in urgent care facility & dx w/anxiety.  Progressively developed weakness of lower legs difficulty walking.  Went to hospital where MRI revealed transverse myelitis & LP was done.  Tx w/high dose steroids x 2 days & transferred to higher level of care for continued steroid dosing.  Improved slowly w/residual weakness right leg.  When seen by rheumatology, had paresthesias in stocking distribution from knees down & in lower back.  Had received unknown injection in right buttock at urgent care facility.  Returned to rheumatology 11/21/07.  At that time, she was continuing to recover from idiopathic transverse myelitis & it was felt that she had no clinical evidence of systemic autoimmune disease.  1/22/08 Reviewed neurologist medical records which reveal when patient initially seen 9/24/07 she experienced occasional tingling of her feet but much improved s/p treatment.  Weakness & bladder control resolved.  Patient able to resume running but is not back to her baseline.  SLE w/u by another physician was reported as neg.  Returned on 11/20/07  Had developed HA x few weeks.  Dx w/tension-type HA & thoracic transverse myelitis, completely resolved.  Returned on 12/12/07 having developed pain, weakness & numbness sensation from armpits around torso & down legs x 2 days.  HA had resolved.  Dx w/thoracic myelopathy & tx w/IV steroids x 3 days & repeat MRI which showed multiple new lesions in brain & spinal cord, some enhancing, c/w MS.  Referred for second opinion.  3/11/08 FINAL DX: relapsing-remitting MS. Reviewed secondary neuro eval of 12/13/2007 which reveals patient experienced tingling in her feet approx 8 days s/p vaccine which progressed as noted previously.  Seen due to recent recurrence of leg & trunk numbness.  Exam at this time revealed brisk reflexes.  Tx w/high dose IV steroids & started on Copaxone. Per 60 day follow up: She has contracted Multiple Sclerosis as a result of this event. She is now receiving treatment from a local neurologist. Her neurologist is certain that vaccine caused this adverse outcome.