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Life Threatening? No
Write-up: Initial and follow-up information has been received from a physician concerning an "otherwise healthy" 13 year old female who was vaccinated with her first and second doses of Gardasil. Subsequently the patient experienced what was thought to be transverse myelitis and was hospitalized. She experienced paralysis from the chest down, lesions of the optic nerve, and was diagnosed with "Neuromyelitis Optica (NMO)". The patient was treated with high dose corticosteroids (unspecified) and did not respond. A course of Cytoxan was planned. Duration of hospitalization was not reported. At the time of the report the patient had not recovered. Additional information has been requested. 5/13/08 Reviewed hospital medical records of 8/1-8/24/2007 & 9/25-9/26/2007. FINAL DX: neuromyelitis optica. Records reveal patient experienced sudden onset of bilateral LEs weakness & numbness proceeded by several hours of leg pains, LBP & urinary retention. Parent w/gastroenteritis several weeks prior. Patient had malaise at that time but never actually ill. Admit exam revealed areflexia bilateral LEs, loss of sensation below T12 bilaterally as well as flaccid paraplegia & urinary retention. Admitted to PICU. Tx w/IV steroids w/no improvement. Tx w/plasmapheresis, I/O cath, bowel regime. Neuro, rheum, psych consults done. Developed decreased sensation up to T8, restarted IV steroids & MRIs repeated. Tspine MRI revealed traumatic progression of disease up to T4-5. No improvement w/additional steroids or plasmapheresis. Tx w/IVIG x 7 days w/no improvement but no worsening. Transferred to inpatient rehab to be readmitted for rituximab in the next month. Medical records of 9/25-9/26/07 for rituximab infusion. Exam revealed loss of motor control of bilateral LEs. Was to return 10/2 for second treatment & PICC placement. Patient continued to be home schooled due to her condition.
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