A 5-month-old male patient weighing 6.78 kg was admitted with a complaint of generalized tonic-clonic seizure for 4-5 times per day for 5 days in pediatric ward of Sir Takhtsinhji General Hospital, Bhavnagar, Gujarat. The patient had an altered sensorium with normal pulse and respiratory rate. Pupil was constricted and poorly reacting to light. Parents revealed the history. The child was vaccinated for the first dose of DPT before 16 days. After 3 days of vaccination, the child developed seizures and admitted to the nearby community health center (CHC) for 9 days. The patient was discharged after the control of seizures and was at home for 3 days without any treatment. Treatment detail is not available on admission at CHC. Reappearance of seizures occurred at home. After that the patient was admitted and treated with phenytoin, methyl prednisolone, and levetiracetam in private hospital at Bhavnagar. Afterward the patient was transferred to our center for further management. There was no history of head injury, trauma, tuberculosis, febrile convulsion, and ear discharge. There was no previous history of seizure before DPT vaccination. Provisional diagnosis as postvaccination encephalopathy was made. Investigations, such as total leukocyte count, differential leukocyte count, red blood cell (RBC) count, packed cell volume, RBC indices, platelet count, erythrocyte sedimentation rate, peripheral smear examination, random blood sugar, liver function tests, renal function tests, and cerebrospinal fluid examination were normal except hemoglobin (10.5 g/dL; reference value: 12.0-18.0 g/dL), LDH (439 IU/L; reference value: 180-360 IU/L), CK-MB (95 IU/L; reference value 18-51 IU/L), and ionized calcium (1.06 mmol/L; reference value: 1.16-1.32 mmol/L). Postreaction CT-scan of brain, MRI of brain and electroencephalogram were normal. The patient was treated with midazolam, phenytoin, levetiracetam, phenobarbitone, and clobazam. After omitting clobazam, clonazepam was added to control seizures at day 5. Acyclovir and methyl prednisolone were started as empirical therapy on the 2nd day of admission. From 7th day onward prednisolone was started. Seizure frequency reduced from 2nd day and last episode occurred on the 13th day. The patient became fully conscious on 8th day. The patient was discharged on 15th day. The patient was followed at 3 months and found without any neurological sequel.
Naranjo's scale showed that the relationship between DPT and acute encephalopathy was probable. According to Brighton criteria for vaccine-induced encephalopathy, the present adverse event was of level 3. According to Modified Schumock and Thornton's criteria, this reaction was definitely preventable and Modified Hartwig and Siegel's scale showed that the reaction was moderately severe.