Pamela Ann Dillon v. HHS - Influenza, transverse myelitis (2014)
Case summary [AI summaries can sometimes make mistakes]
Pamela Ann Dillon filed a petition on December 21, 2010, alleging that an influenza vaccination she received on October 1, 2008, caused her to develop autoimmune transverse myelitis. Ms.
Dillon, born July 23, 1957, had no prior neurological issues. Approximately 16 days after vaccination, on October 19, 2008, she experienced severe back pain, followed by radiating leg pain, constipation, and sensory loss.
Initial evaluations identified degenerative disc changes and ascending lesions of white matter in her spine, consistent with inflammation and transverse myelitis. She received steroid treatment with modest improvement.
A lumbar puncture showed an elevated red blood cell count. On October 27, 2008, a neurologist suggested the transverse myelitis might be secondary to the flu vaccine, and she was diagnosed with transverse myelitis on October 29, 2008.
She underwent inpatient rehabilitation from October 29 to December 11, 2008. In June 2009, she was readmitted with new vision problems and ongoing neurological symptoms.
An MRI at that time suggested the lesion was most suggestive of a cavernous malformation with remote hemorrhage. Cerebrospinal fluid showed elevated myelin basic protein.
By May 2011, an MRI showed a stable lesion consistent with a cavernous angioma. By May 2012, the lesion had grown significantly, and her symptoms had progressed, confining her to a wheelchair.
On July 31, 2012, the lesion was surgically resected and confirmed to be a cavernoma. Petitioner's experts, Dr.
Sidney A. Houff (treating neurologist), Dr.
Lawrence Steinman (neuroimmunologist), and Dr. Robert M.
Kessler (neuroradiologist), opined that the flu vaccine caused an autoimmune response leading to transverse myelitis, with Dr. Steinman citing molecular mimicry and elevated myelin basic protein.
They suggested the cavernoma was not a significant factor. Respondent's experts, Dr.
Thomas Leist (neuroimmunologist) and Dr. Chip Truwit (neuroradiologist), argued that Ms.
Dillon's neurological problems stemmed from the hemorrhaging cavernoma. They noted the lack of typical inflammatory markers, poor response to steroids, and the presence of hemosiderin deposits, indicating bleeding, which they stated do not occur in autoimmune transverse myelitis.
They concluded the symptoms were consistent with a bleeding cavernoma, not an autoimmune response to the vaccine. Chief Special Master Vowell applied the Broekelschen injury-first framework, determining the actual injury before causation.
Based on the surgical pathology and clinical record, she found Ms. Dillon's injury was a cavernoma hemorrhage, not autoimmune transverse myelitis.
Because no plausible theory existed for a vaccine causing a cavernoma, entitlement was denied. Alternatively, the Chief Special Master applied the Althen test and found Ms.
Dillon failed to establish a logical sequence of cause and effect showing the vaccine caused her injury, as her symptoms were a secondary effect of the hemorrhaging cavernoma. Chief Special Master Vowell issued a decision denying compensation on June 25, 2013.
Ms. Dillon sought review, and on January 10, 2014, Judge Nancy B.
Firestone of the Court of Federal Claims denied the motion for review and affirmed the Special Master's decision, finding it was not arbitrary, capricious, or not in accordance with law.
Theory of causation
Pamela Ann Dillon, age 51.25, received an influenza vaccine on October 1, 2008. She alleged this caused autoimmune transverse myelitis. Her symptoms began approximately 16 days post-vaccination. Medical imaging and subsequent surgery revealed a cavernoma (cavernous hemangioma) in her spinal cord, which had hemorrhaged and grown. Petitioner's experts (Drs. Steinman, Kessler) argued the vaccine caused an autoimmune response leading to transverse myelitis, citing molecular mimicry and elevated myelin basic protein. Respondent's experts (Drs. Leist, Truwit) contended the symptoms were caused by the hemorrhaging cavernoma, noting the absence of inflammatory markers and presence of hemosiderin deposits. Chief Special Master Vowell applied the Broekelschen framework, determining the actual injury was a cavernoma hemorrhage, not autoimmune transverse myelitis, and found no plausible vaccine-cavernoma link. Alternatively, applying the Althen test, she found petitioner failed to establish a logical sequence of cause and effect. The Court of Federal Claims (Judge Firestone) affirmed, finding the Special Master's decision that petitioner did not suffer an autoimmune response and thus failed to establish a prima facie case under Althen prong two was supported by the record and not wholly implausible. Petitioner's motion for review was denied. Attorneys for petitioner were Michael G. McLaren and William E. Cochran, Jr. Attorneys for respondent were Ryan Daniel Pyles, Stuart Delery, Rupa Bhattacharyya, Vincent J. Matanoski, and Gabrielle M. Fielding. Chief Special Master was Vowell. Judge was Firestone. Decision Date: January 10, 2014.
Source PDFs
USCOURTS-cofc-1_10-vv-00850