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A fatal case of disseminated tuberculosis coincident with measles-rubella vaccination.

Cheong HK, Yang BG, Sohn YM, Kwon IH, Kim JC, Kim H, Kim JR - Epidemiol Health (2010)

Bottom Line: The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination.Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination.The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.

ABSTRACT
The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray findings. (A) Mild reticular densities were found in both lung fields (June 16th, 2006), and (B) increased reticular densities were mainly observed in both lower lung fields. Small nodular densities were newly developed, but neither cardiomegaly nor pleural exudates were observed. Perihilar lymph node enlargement was suspected (June 25th, 2006, postmortem).
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Figure 2: Chest X-ray findings. (A) Mild reticular densities were found in both lung fields (June 16th, 2006), and (B) increased reticular densities were mainly observed in both lower lung fields. Small nodular densities were newly developed, but neither cardiomegaly nor pleural exudates were observed. Perihilar lymph node enlargement was suspected (June 25th, 2006, postmortem).

Mentions: A 14-yr-old girl developed a mild fever, a chilling sensation, and generalized myalgia from 9:00 pm on June 11th, 2001, after an MR vaccination on the afternoon of the same day (Figure 1). The next day, she developed a high fever of up to 39℃ accompanied by a chilling sensation. She visited a public health center and a clinic, took some cold medicine including antipyretics, but the fever persisted. She had a headache and nausea, which progressively aggravated in spite of medication. On June 16th, she was admitted to a hospital. On admission, she looked acutely ill and complained of headache and discomfort in the upper abdomen. Her body temperature was 39.1℃, and her pharynx was injected, but breathing sounds were normal, and there were no abnormal findings in abdomen. Her hemoglobin was 11.9 g/dL, white blood cell count 1,300/µL, platelet count 100,000/µL, and erythrocyte sedimentation rate (ESR) 10 mm/hr. Her urine contained many red blood cells due to menstruation. On the day of admission, she developed a cough with blood-tinged sputum. Chest and abdominal X-rays were normal (Figure 2A). After admission, despite antibiotic medication including penicillin and tetracycline derivatives, her fever was uncontrolled. Chest X-ray on the third day of admission (June 18th) showed pulmonary infiltration. Laboratory tests showed; aspartate aminotransferase (AST) 364 IU/L, alanine aminotransferase (ALT) 317 IU/L, alkaline phosphatase (ALP) 295 IU/L, gamma-glutamyl transpeptidase (GGT) 156 IU/L, with a normal bilirubin level (June 18th). Viral markers for hepatitis A, B, and C virus were all negative. The Widal test was 1:80 for O antigen and 1:160 for H antigen, negative for active infection. Blood smear for plasmodium was negative. A blood culture on the June 18th was negative. On the sixth day of admission (June 21st), she became slightly dyspneic and febrile, the headache, chill and cough persisted, but chest X-ray findings were unchanged. Sputum smear for acid-fast bacilli was negative with many Gram positive bacteria, and her liver enzyme levels were improved (AST 151 IU/L, ALT 157 IU/L). On the eighth day (June 23rd), because of her parent's strong insist on discharge, she was discharged against recommendation. Medications including oral antibiotics were prescribed. However, no antituberculous medication was given at any time during the clinical course.


A fatal case of disseminated tuberculosis coincident with measles-rubella vaccination.

Cheong HK, Yang BG, Sohn YM, Kwon IH, Kim JC, Kim H, Kim JR - Epidemiol Health (2010)

Chest X-ray findings. (A) Mild reticular densities were found in both lung fields (June 16th, 2006), and (B) increased reticular densities were mainly observed in both lower lung fields. Small nodular densities were newly developed, but neither cardiomegaly nor pleural exudates were observed. Perihilar lymph node enlargement was suspected (June 25th, 2006, postmortem).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2984865&req=5

Figure 2: Chest X-ray findings. (A) Mild reticular densities were found in both lung fields (June 16th, 2006), and (B) increased reticular densities were mainly observed in both lower lung fields. Small nodular densities were newly developed, but neither cardiomegaly nor pleural exudates were observed. Perihilar lymph node enlargement was suspected (June 25th, 2006, postmortem).
Mentions: A 14-yr-old girl developed a mild fever, a chilling sensation, and generalized myalgia from 9:00 pm on June 11th, 2001, after an MR vaccination on the afternoon of the same day (Figure 1). The next day, she developed a high fever of up to 39℃ accompanied by a chilling sensation. She visited a public health center and a clinic, took some cold medicine including antipyretics, but the fever persisted. She had a headache and nausea, which progressively aggravated in spite of medication. On June 16th, she was admitted to a hospital. On admission, she looked acutely ill and complained of headache and discomfort in the upper abdomen. Her body temperature was 39.1℃, and her pharynx was injected, but breathing sounds were normal, and there were no abnormal findings in abdomen. Her hemoglobin was 11.9 g/dL, white blood cell count 1,300/µL, platelet count 100,000/µL, and erythrocyte sedimentation rate (ESR) 10 mm/hr. Her urine contained many red blood cells due to menstruation. On the day of admission, she developed a cough with blood-tinged sputum. Chest and abdominal X-rays were normal (Figure 2A). After admission, despite antibiotic medication including penicillin and tetracycline derivatives, her fever was uncontrolled. Chest X-ray on the third day of admission (June 18th) showed pulmonary infiltration. Laboratory tests showed; aspartate aminotransferase (AST) 364 IU/L, alanine aminotransferase (ALT) 317 IU/L, alkaline phosphatase (ALP) 295 IU/L, gamma-glutamyl transpeptidase (GGT) 156 IU/L, with a normal bilirubin level (June 18th). Viral markers for hepatitis A, B, and C virus were all negative. The Widal test was 1:80 for O antigen and 1:160 for H antigen, negative for active infection. Blood smear for plasmodium was negative. A blood culture on the June 18th was negative. On the sixth day of admission (June 21st), she became slightly dyspneic and febrile, the headache, chill and cough persisted, but chest X-ray findings were unchanged. Sputum smear for acid-fast bacilli was negative with many Gram positive bacteria, and her liver enzyme levels were improved (AST 151 IU/L, ALT 157 IU/L). On the eighth day (June 23rd), because of her parent's strong insist on discharge, she was discharged against recommendation. Medications including oral antibiotics were prescribed. However, no antituberculous medication was given at any time during the clinical course.

Bottom Line: The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination.Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination.The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

View Article: PubMed Central - PubMed

Affiliation: Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Korea.

ABSTRACT
The authors report a fatal case of disseminated tuberculosis in a 14-yr-old girl, which developed immediately after a measles-rubella (MR) vaccination. Despite a markedly accelerated clinical course which led to death within two weeks, the authors could not identify any possible cause of the tuberculosis aggravation in this case, with the exception of the MR vaccination. The possible role that MR vaccination had on the clinical course of tuberculosis in this case is discussed.

No MeSH data available.


Related in: MedlinePlus