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A 15-year-old white boy had been experiencing itchy papules and blisters on sun-exposed areas since he was 18 months old, primarily during the spring and summer. Sometimes, the red papules evolved into painful blisters that oozed clear fluid, became crusted, and healed with scars. Frequently, the lesions also became infected. The patient's mother observed that the eruptions flared several days after sun exposure, but also reported that multiple sunblocks were of no benefit. Over the last 5 years, the frequency of these blistering episodes markedly decreased. The patient's medical history was significant for a bout of iritis with keratitis, occasional oral blisters, and episodes of gastritis. He had no atopic diathesis, and his family history was unremarkable.
On physical examination, there were extensive pigmentary changes on the face (Figure 1), as well as numerous "pocklike" scars left by the primary lesions, especially on the arms. The results of the following laboratory tests and determinations were normal: complete blood cell count, liver function tests, and iron, uric acid, antinuclear antibody, serum Ro/La, porphyrin (serum, urine, and fecal samples), and quantitative urinary amino acid levels. Multiple Tzanck smears were negative, as were viral and bacterial cultures. The findings of screening light tests were unremarkable with a UV-B minimal erythema dose of 30 to 40 mJ/cm2 and a broad-band UV-A minimal erythema dose greater than 20 J/cm2. Photo-patch tests were nonreactive. The results of direct and indirect immunofluorescence studies were negative. A biopsy specimen of an acute blistering lesion was obtained for routine hematoxylin-eosin staining (Figure 2 and Figure 3).
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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