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Administered by: Unknown Purchased by: Unknown
Life Threatening? No
Write-up: Information has been received from a health authority concerning a 12 year old female who on 11/26/02 was vaccinated with a dose of MMR II. It was noted that the pt had a history of "intern hydrocephalus and signs of meningioencephalitis," but the onset of these is unclear. There was no concomitant medication. Eight days after vaccination, on 12/3/02 the pt developed a fever. On 12/8/02 the pt died (cause of death not reported). Follow up information from the health authority indicated that on 12/3/02 the patient developed numbness in her arms and legs. On 12/7/02 the patient developed a fever up to 40.3C. After contact with a doctor, the patient received penicillin treatment (tablets). On 12/8/02 the patient continued to complain about the pain in her legs and arms, and she was vomiting. The patient''s temperature decreaed to 37.3C. The patient was examined by a doctor 1/2 hour before her death. The doctor said that the patient was able to walk in her room and one could talk to her. The results of the autopsy showed, big, swollen, fluid-filled and slightly asymmetric brain with thick membrane and compressed under side. The content of the stomach has been found in the air pathways. There were no other findings. Clinical examinations showed in both lungs insignificant presence of bacteria type haemophilus haemoliticus. Intestinal bacteries type pseudomas aeruginosa was present in the normal range. Antigen examination did not show presence of meningococs type A, B, and C or pneumococcal polysaccharide. The presence of borelia IgG and IgM had not been shown. Examinations of antibody against MMR viruses showed the presence of IgG and IgM against measles and IgM against mumps but not IgG. IT was not founded any signs or acute or earlier infections with measles virus or reaction on this infection. Neuropathological examinations showed chronic changes in the brain membrane as a result of coalescence of the frontal lobe with brain membrane and brain surface reminding inflamed cell infiltration. The pattern of cell infiltration occurred along cavity forms the typical glial scar. It was reported that the chances in the brain membrane had started at least a half hear ago or for several years ago. The health authority assessment indicated that the results of the autopsy and other examinations showed that compression of the brain causes death from lack of breathing or heart stop. The changes in the brain membrane indicated that earlier cerebrospinal memingitis resulted in the formation of a cavity. The assessment noted, it is unclear if the increased fluid content in the brain was the result of MMR vaccinatoin or infection, possible influenza. However, the results of the examinations showed that the most likely, the increased fluid in the brain and resulted compression of the brain was the consequence of virus infection during earlier cerebrospinal meningitis resulting in formation of cavity in the brain. Follow up information, in the form of an autopsy report, indicated that the patient developed afever and felt well on 12/3/02 on her way home from school. The family took it to be influenza, as a number of families had had it. On 12/8/02 the patient continued to get worse, vomiting and still complaining of a sensation of heaviness and pains in her arms and legs. Post mortem findings were: stomach contents found to have been sucked down into the airways, and an large, swollen, fluid-filled and slightly asymmetrical brain with thickened meninges and signs of pressure on the underside. No pathological changes otherwise. Additional examinations indicated that a full bacteriological examination was carried out, indicating only isolated bacteria of the type haemophilus haemoliticus in both lungs, and these were not attributed any significance. Cultures were taken for pathogenic intestinal bacteria, indicating the presence of naturally occurring pseudomonas aeruginosa. No antibodies were found for rubella. It was noted that the results for mumps antibodies were consistent with a recently administered vaccination, and no previous infection with rubella, or sign of reaction ot the administered vaccine was demonstrated. The neuropathological examination revealed chronic changes, with a thickened meninx and subsequent coalescence of the frontal lobes and attaching of the meninges to the surface of the brain, plus the presence of small inflammatory cell infiltrates. Isolated inflammatory cell infiltrates were observed around the vessels and along their cavities, plus the presence of scar tissue in the form of so-called gliosis. The changes were interpreted as an existing result of a previous inflammation in the meninges and brain tissue, which had taken place at least 5 years ago, or possibly more. Brain atrophy was demonstrated and an enlarged brain cavity wsa noted. Acute fluid accumulation was also found in the brain, with signs of the cerebrum having been pressed down around the brain stem. The conclusion was that, cause of death may be assumed to be respiratory and cardiac arrest resulting from downward pressure on the brain. It was noted that changes found in the brain indicated a past meningeal and brain inflammation, with a subsequently enlarged brain cavity. It was further noted that of relevance is the finding of pronounced fluid accumulation and subsequent downward pressure from this. The extent to which fluid accumulation in the brain was caused by MMR vaccine or an infection, possibly influenza, cannot be determined with certainty, but based on antibody determinations and culture results, it is most likely that fluid accumulation and subsequent downward pressure on the brain arose due to a viral infection in either the previously inflamed meninges or brain (which had occasioned an enlarged brain cavity), in an already weakened 12 year old girl. It was noted that the pt was examined for IgG and IgM for measles, mumps and rubella, but no results were reported. Additional information is not expected. Case closed.
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