Received Aug 4, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| ANTH | ANTHRAX (BIOTHRAX) | EMERGENT BIOSOLUTIONS | 1 | 300216A | SC / RA |
| HEP | HEP B (ENGERIX-B) | GLAXOSMITHKLINE BIOLOGICALS | 3 | CTCT327 | IM / RA |
| TYP | TYPHOID VI POLYSACCHARIDE (TYPHIM VI) | SANOFI PASTEUR | 1 | X1A271M | IM / LA |
| YF | YELLOW FEVER (YF-VAX) | SANOFI PASTEUR | 1 | UK217AA | SC / LA |
18 y/o previously health male received AVA, Hep B, ViCPS, and YF-VAX on 05 May 2025. On 08 May 2025 he presented to the primary care clinic for a 2 day history of a "rash", brusing and blood in tissue when wiping his nose. Exam revealed generalized petechiae, and bruising to bilat legs, knees, and upper arms, back and trunk as well as dark/black spots of bruising in mouth. He was sent to the ER. At (withheld name) ER, his initial labs were notable for significant leukopenia/thrombocytopenia (WBC 3, Hgb 13.5, PLT 4, ANC 2000, ALC 600).
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Azithromycin (rash)
He was provisionally diagnosed with ITP and admitted at (withheld name) from 5/8-5/13 where he received Decadron 40 mg daily, IVIG x2 (5/9), PLT x1 (5/12) and romiplostim (5/13). He was transferred to Medical Center (withheld). At the time of transfer his cytopenias deepened with WBC of 2.1, Hgb 10.5, and persistent thrombocytopenia6k. Pediatric Oncology was consulted. He underwent at BMA/Bmbx on 14 May which demonstrated a hypocellular marrow without concern for malignancy. He was tranferred from (withheld facility name) to withheld facility name) in (withheld state) on 21 June 2025 to be closer to family where he remained inpatient from 21 June through 11 July. While hospitalized he has remained transfusion dependent for pRBC and platlets. He developed persistent fevers with work-up including Karius testing of blood showing low levels of Alcaligenes faecalis and a Fungitell test result of 70 pg/ml for which he was treated and discharged on 7/11 on levofloxacin and fluconazole prophylaxis. He was subsequently readmitted with recurrent neutropenic fevers on 7/20 but is otherwise asymptomatic, still awaiting BMT (sister is a match). Currently on cyclosporine, ATG, and eltrombopag and requiring multiple platelet transfusions. Patient has had normal LFTs, Cr, INR, PT/PTT. No hypoxia or hemodynamic instability. Bone marrow biopsies (5/14 and 6/25) aplastic anemia (PNH panel negative, cytogenetics non-diagnostic [no cells to analyze], chromosome fragility testing pending) Infectious diseases testing: Blood and urine cultures negative Hep B sAg negative HCV Ab negative Parvovirus PCR negative CMV IgG+, PCR negative EBV PCR x 4 negative Arboviral serology panel negative HHV6 serologies negative HSV 1/2 PCR negative HIV negative Cryptococcal antigen negative Galactomannan negative Beta-D-glucan + Histoplasma antigen negative R Typhi- neg C Burnetti- neg R Rickettsia - neg Q-fever and rickettsial testing negative Imaging: CXRs nl CT brain nl CT C/A/P slightly enlarged cervical LNs; fluid collection around rectovesical pouch MRI free fluid in pelvis of unclear etiology Noted: AVA was documnted in the record as being administered as a Subcut injection, not IM. This may be a docmentation error, but AVA for PrEP should be administered IM. CAPT (withheld name) from CDC is following closely as well as the (withheld) Immunization Healthcare Division (POC withheld name-see contact info above).