Age: 75.0
Sex: F
Vaccine: VARZOS
Symptoms: Vaccine breakthrough infection, Visual impairment
Clinical narrative: Patient is a 75-year-old woman that I follow with a history of a resection of a Grade 1 chondrosarcoma of the left rib in February 1999. She has not received chemotherapy and has no known history consistent with immunosuppression and is not on any immunosuppressive medicines. The patient had chicken pox as a child and never had shingles and was asking about the shingles shot when I saw her 11/15/2006. The risks and benefits were discussed with the patient and she did receive the shingles shot on that day. Five days later, the patient started having some right face pain about the right orbit. It was initially below the eye and she thought she had a dental problem and went to see her dentist on 11/22/2006. He said there was no problem here. She never had any itching or any type of rash until 11/23/2006 when she thought she had an outbreak of rosacea along the bridge of her nose on the right going over to her cheek on the right. On 11/24, she saw doctor who immediately diagnosed shingles and sent her to see another doctor. The doctor noticed increased ocular pressure and some dendritic changes on her eye exam. The patient was placed on drops to lower the pressure and had her come back on the 11/28. I spoke to the patient on the 11/27. She was not having pain. She was not having itching. We decided not to put her on steroids at that time, because we were concerned about the effects on her eye. The patient was not having fevers, was not having lesions anywhere else and had, had a thorough exam with the doctor that day. I spoke to the patient today on 11/28. She was seen by the other doctor. Her eyes are much better. She is being placed on steroid drops and was calling to ask about oral steroids. The theoretical risk and benefits were discussed with the patient. Giving her small size, age, and lack of symptoms at this time, I recommending steroids, but a little bit of an attenuated dose of 40 mg daily for two days, and 20 mg daily for two days, to try to reduce inflammation in this area. She knows that if she should have lesions anywhere else, that she is to call me immediately. If she should have fevers or feel worse or have eye pain, she is to call me immediately. She was placed on VALACYCLOVIR by doctor, 1000 mg three times daily which she is tolerating well. The patient will see doctor again on Thursday, see another doctor again next Monday, and see me this Friday going into the weekend. She does have some small vesicles at this pint. She has no crusting over the lesions at this time. She understands that she is highly infectious and is to avoid people that are on any form of immunosuppression or pregnant people. I did review with patient, FDA guidelines and findings from the physician's desk reference insert on this medicine. This was not described in 21,000 people who were treated with it earlier. The time frame without a doubt is concerning however. No new recommendations at this time. Disability as of 2010: Vision in right eye impaired-20/100, daily steroid eye drops required, daily 400 mg Acyclovir required (to date-46 visits to ophthalmologists).