L.C. v. HHS - DTaP, juvenile idiopathic arthritis (2017)

On August 21, 2013, Eric and Carol Cabrera, as natural parents and guardians of minor L.C., filed a petition under the National Vaccine Injury Compensation Program. They alleged that L.C. developed juvenile idiopathic arthritis (JIA) as a result of receiving a diphtheria-tetanus-acellular pertussis (DTaP) vaccine on August 30, 2010.

Petitioners argued that the DTaP vaccine caused L.C.'s JIA, proposing molecular mimicry as the mechanism. They presented expert testimony from Dr.

Arthur Brawer, a rheumatologist, who opined that the vaccine triggered an autoimmune response leading to JIA, with onset in September 2010, prior to any intervening infections. Respondent recommended against compensation, arguing that L.C.'s JIA was genetically determined and that concurrent ear infections and influenza in late October 2010 were more likely causes, with an onset date in late October.

The Special Master reviewed the entire record, including expert reports and testimony from Dr. Brawer for petitioners and Dr.

Carlos Rose for respondent. The medical records indicated L.C. was born on January 21, 2010.

Videos from August 2010 showed him using both legs normally. Following the DTaP vaccination on August 30, 2010, L.C. began crawling at the end of September 2010, exhibiting an abnormal gait with his right leg extended to the side, which his parents initially attributed to normal development but later recognized as pain behavior.

By late October 2010, L.C. experienced noticeable pain in his right knee and difficulty bearing weight. Medical evaluations led to a diagnosis of JIA and uveitis.

An MRI in January 2011 showed synovial hypertrophy and modest synovial hypertrophy. L.C. had a positive anti-nuclear antibody (ANA) test in February 2011 and was positive for the HLA-B27 gene.

A repeat ANA test in March 2011 was negative. Between October 2010 and March 2011, L.C. had multiple ear infections and a positive influenza A screen.

In March 2011, he was hospitalized for knee swelling, limp, and fevers, leading to a diagnosis of JIA and treatment with anti-inflammatories and physical therapy. He was later diagnosed with uveitis, evidenced by keratic precipitates.

Dr. Brawer opined that the DTaP vaccine triggered L.C.'s JIA through molecular mimicry, with onset in late September 2010, before the ear infections and flu.

Dr. Rose opined that L.C.'s JIA was spontaneously and genetically determined, likely enthesitis-related arthritis (ERA), with onset in late October 2010, making the concurrent infections the more likely cause.

The Special Master found that the evidence, including parental testimony and video analysis, supported an onset date in late September 2010. The Special Master concluded that the DTaP vaccine was the most likely trigger for L.C.'s JIA, accepting molecular mimicry as a reasonable, though not definitively proven, mechanism that satisfied the Althen prongs for causation.

Therefore, entitlement to compensation was granted. The petition was filed on August 21, 2013.

An interim award of $25,000.00 for attorney fees and costs was made on June 25, 2015, by Special Master Thomas L. Gowen.

The final decision on entitlement was issued on February 7, 2017, by Special Master Thomas L. Gowen.

Petitioners' counsel was Thomas P. Gallagher, Esq. and Ronald C.

Homer, Conway, Homer & Chin-Caplan, P.C. Respondent's counsel was Darryl Wishard, Esq. and Darryl R.

Wishard, United States Department of Justice.