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The Rash

Needle DripThe patient was a 17 year old female. She had a rash. The number of patients with rashes in the ED seems to be steadily increasing for some reason.
According to the previous records, she was diagnosed with a yeast infection. Her primary care physician started her on Diflucan and on topical ketoconazole for good measure.
Her rash became worse. It had now extended up her back. The patient’s mother called the patient’s primary care physician who recommended that she go to the emergency department.
Hmmmm. Probably some type of contact dermatitis or perhaps a reaction to the topical medication, I thought as I walked into the room.
The first thing I noticed was the patient’s motorized wheelchair. Braces for the patient’s arms were built into the wheelchair. Sitting on the bed, the patient appeared paralyzed. She was able to move her head to some degree. The patient’s arms were propped up on pillows. Her legs were somewhat contracted. She had difficulty speaking, so her mother provided me with most of the history.
So the etiology for the rash changed a little bit based upon this initial presentation.
Getting the history from the mother was easy. She was intelligent, articulate, and had tried OTC medications for the rash already. She had even consulted Dr. Google to see if she could determine what the cause of the rash was.
“I thought it could be a reaction to the medication, so I stopped it. I’m not a doctor, though, but if it was a reaction to the Diflucan, wouldn’t the rash be all over her body?”
Exactly.
I got some more history.
No other medical problems.
No other medications.
Then I asked about immunizations. The mother remained polite, but became very curt. “No, she doesn’t get immunizations any more. She hasn’t received them since she was 13. Thank you, though.”
It was a curious response, so I asked “Do you mind if I ask you why?”
She became teary-eyed. “My daughter wasn’t always like this,” she said.
“She was a normal kid until she turned 13. On the basketball team. Played soccer. Then I decided to protect her by giving her the Gardasil vaccine. She developed weakness 4-5 days later. A week later she was on a ventilator. Two weeks after that she coded and almost died. She was in the ICU for over a month with a trach. This is what a vaccine did to her. So hopefully you can understand why we don’t vaccinate our children any more.”
I nodded my head.
After examining the rash and how she sat in her chair, it appeared that the rash pretty closely matched the back of her chair. Probably contact dermatitis of some sort.
I told the mom that we could give her a short course of steroids, but that hopefully the rash would resolve if she could avoid contact with the back of the chair for a short while.
The mother was very gracious and thanked me. I helped the patient’s sister and her mother get the patient back into her wheelchair. The patient smiled and slowly thanked me.
I was so impressed with the entire family and their graciousness, but I couldn’t help being profoundly saddened by the visit.

I advocate vaccination.

But I have to admit that my confidence was a little shaken by this patient’s story. And I can’t say that I won’t think twice about letting my three daughters receive the Gardasil vaccine.
Irrational?
Maybe.
I know that vaccines have help to largely eradicate many harmful communicable diseases.
But however irrational the thought may be, the picture of a healthy young girl in a soccer uniform dangling from that same girl’s motorized wheelchair is one that is difficult to erase from my mind.

4 comments

  1. The Gardasil vaccine is very safe. And even if it wasn’t, the benefits outweigh the risks.
    We all tend to take the bad cases personally, and maybe that’s even a good thing, because it makes us more aware of things. But nevertheless, vaccines are on the top 3 things that revolutionized medicine, and we should never forget, regardless the amount of adverse effects our patients have – that we’re practicing Evidence-Based Medicine.

    http://en.wikipedia.org/wiki/Gardasil#Safety

    I hope your patient is doing well, and have a great week!
    Yuval

  2. WC-
    I was about to give my oldest daughter the second round of Gardasil when the stories came out about “normal” teens getting sick from this. My formerly military trained self looked into this with a fine-toothed comb. I decided that I would not finish it out. If my girls want to, before they are 26, they can do it, but I think the risks were too much. There were no apparent links or commonalities in the girls with adverse reactions– and I couldn’t see the benefits outweighing the risks at that point. Here’s hoping that my own “risk” proves correct and potential diseases remain at bay because of cogent behaviors. That is a heartbreaking story and it makes me sad. I have a friend who is a drug research scientist. He kinda sorta told his boss that the drug he worked on should not be approved and was blacklisted and fired in days. Gotta love the approval process of the FDA…even when Pharma spends the big bucks and tries to tell you it’s not safe, they can eff up your career.

  3. We all must struggle in medicine to accurately weigh risks against benefits, since there is no risk free course of action available. Although there is risk to vaccination, a physician ought to put the risks into perspective by considering the potential benefits, in this case the prevention of some cases of cervical cancer, venereal warts, and perhaps other cancers. I wish we had better less risky ways of helping people, but it is clear that vaccines are far more likely to be substantially beneficial than to be harmful.

  4. I worked in a pediatric hospital and the 1st year the vaccine was available, we had 3 very similar cases. It has made me think twice re: the vaccine with my 3 daughters. We do the other vaccinations, but I talk with my daughters about the risks and benefits. So far we have not done the gardasil.

    I again think that vaccines do a lot of good, but I also believe that they are not without risk. I wish the medical community would spend more energy researching who is at risk for vaccine reactions. I’m tired of my only 2 choices being everyone should vaccinate against everything all the time or no vaccines-they are responsible for every illness and are just recommended for the profit of drug companies.

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