title: Rare case of fatal yellow fever vaccine-associated viscerotropic disease.
abstract: This report describes a case of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) that occurred after vaccination in a 22-year-old female. Our patient presented with a clinical syndrome of fever, headache, nausea, and vomiting, which quickly progressed to multiorgan failure and ultimately death on hospital day 4. YEL-AVD is an extremely rare condition reported only a few times in the literature. The yellow fever vaccine is a known stimulus of systemic inflammation in the body. A mild subclinical viremia develops, which results in a persistent and robust T-helper-cell-dependent antibody response with long-lasting immune protection. The very rare patient may have an aberrant response to the 17D vaccine strain, causing the multiple organ system failure seen in YEL-AVD. Predisposing host factors that contribute to YEL-AVD are not yet known. Treatment for YEL-AVD is supportive. To the authors' knowledge, this patient was the first to have YEL-AVD as a result of standard US military vaccination protocols.
authors: Infectious Disease Service, Department of Internal Medicine, Madigan Army Medical Center, Tacoma, WA 98431-1100, USA. gregg.gerasimon@amedd.army.mil
authors: Gregg
authors: G
authors: Gerasimon
authors: Kristie
authors: K
authors: Lowry
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000209:etiology; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology; D022341:Yellow Fever Vaccine / Q000009:adverse effects*
chemical_list: D022341:Yellow Fever Vaccine