Reporte zur Charge N014485

Symptomtext

Patient received both MMR (right thigh) and separately VZV (left thigh) vaccine on 6/25/18 in setting of known chronic neutropenia. On 7/5/18 the family presented for a visit given on 7/4/18 he woke up fussy and annoyed. Tactile temp was noted but no temperature was measured initially. Overnight into 7/5/18 the patient felt hot to touch and temporal/rectal thermometer showed a temp of 99.7 F. Exam on 7/5/18 in clinic reported a fussy infant and shotty cervical adenopathy along with an 1 cm x 1 cm erythematous lesion on the left lateral thigh along with some sparse red dots on skin. Tmax was 100.2 F. Given patient's fussiness, labs were collected (including a blood culture) and given a dose of IM ceftriaxone. Plan made if still neutropenic to admit. ANC was (accounting for bands) 90 (prior level on 6/4/18 was 474) so patient admitted on 7/5/18 PM. Patient received ceftazidime empirically and was monitored. No frank fevers noted and patient was subsequently discharged 7/7/18 after ANC slightly improved (1%-- >4% ANC 188) and blood cultures were no growth.