Age: 18.0
Sex: M
Vaccine: MNQ
Symptoms: Back pain, Condition aggravated, Guillain-Barre syndrome, Hemiparesis, Hypoaesthesia
Clinical narrative: This initial report was received on 14/Feb/2006 from health care and was the result of Menactra and GBS rapid cycle analysis performed for the CDC. An 18 year old male patient, with a medical history of Guillain Barre syndrome/CIDP (chronic inflammatory demyelinating polyneuropathy) since age ten and chronic now in his disease, received an injection of Menactra, lot number not provided, on 19/Jul/2005. At age ten this patient was diagnosed with Guillain Barre syndrome. He was given IVIG, and then he was treated with plasma exchange. He seemed to return to normal, and stayed with pretty good function for about three to four months. Symptoms then recurred. He had a repeat spinal tap with a protein of 105. Plasma exchange this time did not help. He became non-ambulatory. His weakness has always seemed to be much greater distally than proximally, but his function has fairly significantly impaired and he went to a rehabilitation center. The patient was put on prednisone for several months. The patient was put on Cytoxan by the year 2000, and he had significant improvement although his ankles remained quite weak with the right more so than the left foot drop problem. He also developed scoliosis and again he stayed overweight and developed some back pain problems. The patient stated he has numbness in his feet as part of this. The patient has improved and stable for several years, and then 2004 started having a worsening again of his symptoms. He received Cytoxan again, and he was not improving by two months, and CellCept was added but patient developed side effects. Patient had some improvement but not to satisfactory level. In the beginning of 2005, he underwent a desensitization to IVIG (he previously experienced an allergic reaction) which was successful. Since then he was given Solumedrol, Tylenol, Benadryl premed then 500mg/kg of IVIG daily x 4 days once a month for 4 months. His last dose of IVIG was Aug/2005. In January 2006, the patient reportedly noticed some weakness in his fingers and hands, approximately six months post-vaccination. Elevated CSF results from a lumbar puncture of 30/Jan/2006, included, protein of 98 (elevated from 60 in Jun/2005) and WBC 10/uL (elevated from 0 in Jun/2005). The patient was admitted to the hospital, on 03/Feb/2006, for treatment with Solumedrol, Tylenol, Benadryl and IVIG. On that date, besides the weakness of the fingers and hands, the patient denied further complaints. He moved all four extremities equally well. Cranial nerves were intact. There were no focal neurological deficits appreciated. He was alert and oriented x 3. Memory and speech was intact. Unfortunately, the medication ordered for the patient was not available, and the patient was discharged on the same day he was admitted. He was rescheduled for admission on 08/Feb/2006. Additional medical history includes severe kyphoscoliosis with a spinal fusion x 3, restrictive lung disease, obstructive sleep apnea, cystic acne, migraine headaches, depression, bipolar disorder, Asperger-like features, clostridium difficile colitis, chronic right abdominal pain syndrome, obesity, pseudotumor cerebri, "varicella or vaccine," MRSA carrier, chronic skin ulcer, bowel perforation with cecostomy, right foot surgery and torsion of the testis/epididymis.