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Case Study

A 5-year-old boy with a vesicular facial rash one day after contact with an herbicide

A 5-year-old boy is brought to your office after acute onset of a rash on his face and arms. The rash consists of small blisters with surrounding erythema, which the patient states itch and burn. The boy’s mother says she noticed the rash on her son’s face last evening, and by morning it had spread to both arms. The child also complains of a headache and stomachache that began early this morning. His temperature is normal.

Further history reveals that the patient and his family moved to this Midwest rural area 2 years ago; their farm is adjacent to a wooded area. Two days ago, workmen from a utility company sprayed beneath the high-voltage power lines that traverse the back edge of the property where the children frequently play during the summer. On questioning, the workmen told the mother they were using an herbicide, but assured her the area would be safe for the children in a few hours. The mother asks you if the defoliant could have contained dioxins, and, if so, whether her child has been affected. Her concern stems from what she has heard about alleged effects of Agent Orange on Vietnam veterans.

Medical history and chart review reveal the child has had no major illnesses. He has had a normal pattern of growth and development, both physical and psychosocial. Immunizations are up to date.

(a) What further questions would you ask while taking the medical history?

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(b) On what aspect of the boy’s physical examination should you focus to address the mother’s concern?

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(c) What laboratory tests are appropriate to aid in the diagnosis?

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(d) Are dioxins likely to be the cause of the boy’s rash? Explain.

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Answers to the Pretest are incorporated in Challenge answers (6) through (10) on page 16.



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