Received Apr 10, 2026
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| SMALL | SMALLPOX (ACAM2000) | EMERGENT BIOSOLUTIONS | N/A | UT8076NA | IM / LA |
Chronology of symptoms: Saturday 9/9: Flu vaccine given Sunday 9/10: Bilateral lower extremity pain, "muscle soreness", pain over shins/feet however responding to ibuprofen; went roller blading earlier in the day and no functional limitations Monday 9/11: Woke up with bilateral lower extremity pain but wanted to go to school. Took Motrin and biked to school without difficulty. In the evening, reported bilateral leg pain so sat with heating pad which provided some relief. Went to sleep. Tuesday 9/12: Woke up with bilateral pain again so took another dose of Motrin. Biked to school. Mother called by school nurse for fever and worsening symptoms of lower extremity pain/heaviness, unable to ambulate. Also having some snesory changes to right torso progressing to abdomen and then to left torso. Mother picked up from school and took pt to PCP. En route, pt mentioned pain/stinging with voiding. By evening reported having difficulty "pushing pee out". Mother called on-call doctor and then proceeded to EC when pt unable to void. Wednesday 9/13: +urinary retention, difficulty walking, bearing weight, fever, brief episode of right eye blurry vision that resolved, found to have UTI and admitted to hospital.
URI 2 weeks prior
none
Motrin
none
Pt is a previously healthy 10 y.o. F who presented with myalgias, leg pain and weakness progressing to inability to walk, and bladder pressure. She was brought to the EC where her symptoms progressed into blurry vision, back pain, numbness in extremities, and gait instability. She was initially diagnosed with UTI due to UA with WBC and started on antibiotics at this time as well and was reportedly improving in the EC however due to her constellation of symptoms neuro recommended admission and further evaluation. On imaging, MRI showed diffuse white matter lesions consistent with diffuse myelitis however in the absence of encephalopathy. At this time, Neuro suspected MOGAD vs ADEM and additional laboratory evaluation was sent per their recommendations including a MOG antibody titer, which was positive. She was started on 7 days pulse dose solumedrol followed by 5 days of IVIG for immune suppression. While on her steroid dose she began to have intense behavioral changes requiring clonazepam then risperidone, and she was seen by psych and psychology for further outpatient follow-up. Ophthalmology performed an eye exam which was normal. Due to her neurogenic bladder, she received q6h CIC with bladder scan until spontaneous voids returned. Urology was consulted for management and opted for conservative approach given her good return to baseline and will follow outpatient. PM&R was consulted given her weakness and gait instability and upon initial assessment thought she would benefit from IRU placement following discharge. However, pt made excellent progress in her PT and ADL gals while admitted and so upon re-assessment will discharge to home acute outpatient therapy and follow-up in PM&R clinic. At time of discharge, pt has completed 7d pulse dose solumedrol and will continue on a 6 week prednisone taper. She has received 5d of IVIG. She is voiding spontaneously and able to ambulate without assistance, however has walker and homecare DME at bedside for needs at home. She will continue on gabapentin per neuro recs, and start sertraline and prn risperidone for anxiety associated with her condition and hospitalization. She is otherwise afebrile, tolerating PO, with near return to mental and physical baseline.