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Welcome to the August 27 edition of The Differential. Created by physicians for physicians, this high-quality pediatrics briefing is designed to be quick (skim it in just a few minutes) and thorough (all the information you need is in this email).

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Single-Sentence Summaries

1. A Consumer Reports analysis concludes that there are high levels of arsenic, cadmium, and lead in many popular baby and toddler foods. Consumer Reports, Aug. 2018.

2. Methadone may be safer and more effective than morphine for treatment of neonatal abstinence syndrome. JAMA Pediatrics, Aug. 2018

3. In communities that implemented legislation designed to increase childhood HPV vaccination rates, adolescent sexual activities did not change. AAP, Aug. 2018

4. Prenatal DTAP vaccine is not associated with postnatal development of autism. AAP, Aug. 2018

5. Maternal depression alters stress and immune biomarkers in mother and child. Depression and Anxiety, Aug. 2018

Clinical Quiz

A 4-year-old boy with known G6PD deficiency is brought to the pediatrician by his mother with a blistering pruritic rash. On examination, numerous tense vesicles and bullae are seen on his neck, lower abdomen, and extremities. Ulcerative lesions on his buccal mucosa are also noted. Direct immunofluorescence of a skin biopsy later reveals linear deposits of immunoglobulin A (IgA) at the dermoepidermal junction. Which of the following treatments is recommended for this patient?

A. Mitral valve disease
B. Subacute sclerosing panencephalitis
C. Cataracts
D. Infertility

Answer at the bottom of this email, or click here to see the full case and discussion on Figure 1.

Editor’s Pearl

This week’s pearl — One Pill Can Kill — comes from Missouri Poison Center.

Medications that can be lethal when consumed by children - even just one pill:

  • Alpha-adrenergic blockers (clonidine)
  • Antimalarials (chloroquine, quinine)
  • Beta blockers Buprenorphine (Suboxone®, Subutex®)
  • Calcium channel blockers
  • Camphor
  • Carbamates/organophosphates
  • Caustics
  • Imidazolines (oxymetazoline, tetrahydrolazine)
  • Opioids
  • Sulfonylureas (e.g., glipizide, glyburide, glimepiride)
  • Toxic alcohols (ethylene glycol, isopropanol, methanol)
  • Tricyclic antidepressants

CLINICAL QUIZ ANSWER:

D. Sulfapyridine

This patient’s presentation is indicative of linear IgA bullous dermatosis (LABD), a rare autoimmune disease characterized by the acute onset of a blistering rash, often accompanied by mucosal lesions. Linear deposition of IgA at the dermoepidermal junction is pathognomonic of the disease. LABD can be drug-induced or occur idiopathically, and is typically treated with dapsone. However, its use is associated with an increased risk of severe hemolytic anemia in patients with G6PD deficiency, and as such, should be avoided. A second-line therapy such as sulfapyridine is recommended in these cases.

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