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Administered by: Unknown Purchased by: Unknown
Life Threatening? No
Write-up: Case received from foreign Health Authority on 23-MAR-2009 under HA reference no. PEI2009004813. It was reported by a physician that 17 year old female patient with a positive family anamnesis of multiple sclerosis (aunt of the patient, currently without symptoms) and medical history of preexisting left-frontal headache and left-temporal brain substance defect (probably due to an craniocerebral injury in childhood) was vaccinated with three doses of GARDASIL (Lot # not reported) in 2007 (exact dates not reported). On 08-FEB-2007 the patient was vaccinated with Tdap (manufacturer unknown), on 22-MAR-2007 with a dose of HBVAXPRO (Lot # not reported) and 18-APR-2007 with a dose of TWINRIX, Lot # not reported) and finally on 31-MAY-2007 with HAVRIX (lot # not reported). Between 15-JAN-2009 and 20-JAN-2009 she experienced visual disturbance which led to diagnosis of suspicion of clinical isolated syndrome. On 09-FEB-2009 she experienced hemilateral weakness for seconds or minutes without nausea and headache. Neurological examination and psychic exploration were normal. Findings: Cranial MRI showed several lesions centrally located in the medulla oblongata without enhancement of contrast medium. MRA on 11-FEB-2009, MRI of cervical and thoracic spine, VEF, EEG on 16-FEB-2009, tibial sep. Neurological and psychological investigations showed normal results. Routine laboratory findings were normal. CSF diagnosis: 390/3-cells (<15), total protein: 49mg/dl, lactate: 14mg/dl, detection of intrathecal IgG synthesis and oligloclonal bands, slight barrier disorder, albumin quotient: 4.2, varicella zoster IgG (CSF): 27IU/l (<4.5), ASI: 2.01 (no confirmation of intrathecal antibody synthesis). Infection serology (borrelia, varicella zoster, CMV, toxoplasmosis, mumps, measles, influenza A and B, HSV, FSME, EBV and rubella) detected no acute infection. ACE and ANA were normal. Brain stem encephalitis was diagnosed. It was discussed whether brain stem encephalitis was within a CIS or ADEM. MRI was not in favor of ADEM but could be seen within CIS. A possible differential diagnosis would be a viral brain stem encephalitis. The reporter suspected a multiple sclerosis. The patient was treated on an outpatient basis. She received URBASON in high dose (1g) and CEFTRIAXON during 5 days. Follow up examination with MRI control was planned. It was reported that multiple sclerosis, sensorimotor, encephalitis and neurological symptoms were considered other important medical events. Other business partner numbers include E2009-02498. Additional information has been requested.
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