Age: 1.25
Sex: M
Vaccine: DTAPH, HEP, PNC
Symptoms: Immune system disorder, Irritability, Laboratory test abnormal, Osteomyelitis, Pain
Clinical narrative: Following vax, the pt developed pneumococcal bacteremia osteomyelitis. This event is considered "medically important". Additional info recvd 8/12/01 indicated blood culture, bone scan and x-ray of the distal femur were performed. The pt was being treated with an unspecified IV antibiotic. The reporter suspected an "underlying immunocompromise." F/U information states that the pt had a medical history of recurrent ear infections and a spontaneously draining ear. The pt developed pneumococcal osteomyelitis following receipt of the 4th dose of Prevnar. Blood culture was positive; the bone scan was negative "on day 4". The X-ray of the pt's distal femur "on day 12" was positive. The pt was being treated with an unspecified IV antibiotic. F/U info received on 9/27/01, indicated that the pt received his 4th doses of Prevnar and TriHibit, as well as his 3rd dose of Engerix-B on 7/26/01. The pt had a medical history of multiple infections including recurrent otitis media (PE tubes inserted), cellulitis of his fingers and a neck infection. Two weeks prior to admission, he developed a cough and runny nose. On 7/22/01, the pt's mother noticed that her son was tip-toeing on his right foot. He then refused to walk and mostly crawled. He was irritable and had developed an intermittent low-grade fever which ranged to 100.1F. The pt was seen by the pediatrician; X-rays of his extremities were performed and were normal. On 7/25/01, he was seen again by his pediatrician and was noted to bear more weight on his right leg. His activity level had increased. On 7/27/01, the pt's activity level had decreased and he was admitted to the hospital on 7/28/01. He was seen by an infectious disease physician on 7/29/01. Physical exam revealed "positive" PE tubes. His extremities were difficult to examine because the pt cried when moved. He refused to walk. When he attempted to ambulate, his right leg was externally rotated. Ultrasounds of his hip and knee were performed and were negative. While hospitalized, the pt experienced 1 episode of fever. The pt was treated with IV vancomycin. The sensitivity of the Streptococcus pneumonia showed that the organism was highly resistent to penicillin; the pt was considered for and treated with linezolid. Prior to discharge from the hospital, an X-ray of his femur was performed; results were not available at the time of discharge (date of discharge not specified). On 8/4/01, the pt's mother contacted the infectious disease physician and reported that her son was less active (he wanted to crawl instead of walk) and he was fussy. The physician obtained the X-ray results. The X-ray revealed a small focus of destruction in the right distal femur, consistent with early osteomyelitis. He was re-admitted to the hospital on 8/5/01 and the linezolid was discontinued. On hospital admission, the pt was afebrile. On physician exam, there was full range of motion at his hips and knee joints. No focal area of tenderness was noted; however, tenderness or warmth was noted a the medial aspect of his distal femur. The pt was treated with vancomycin and ceftriaxone. Since the pt's CXR, CSF culture and bone scan were negative, the physician indicated that the pt had an unspecified source of bacteremia. Two serum samples were to be tested for antibodies on 8/2/01 and 8/27/01. Results were not provided. The physician's assessment was probable osteomyelitis of the right distal femur, probably due to Streptococcus pneumonia. The physician also indicated the need to rule out immune deficiency.