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Last week at Port Antonio Peds clinic we were referred a patient from the health center. He was a 6 month old male who was referred to us for concerns of hypotonia. Upon further history, we learned he was a term baby, growing and thriving, and mom had been concerned about his tone for quite some time. The nurse at the health center also noted some nystagmus at rest. On our exam, he was not dysmorphic, HEENT, CV, Lungs, Abd were normal, though neuro was not. He was hypotonic diffusely, though normal muscle bulk. He was also hyporeflexic in all major muscle groups. His Fontanelles were still open, and maybe a bit on the wide side. His eye exam was significant for horizontal nystagmus at rest, and exagerated with eye movement. His pupils responded to light and he blinked to light, though did not focus or react to any visual stimuli.
We had many concerns about this baby, specifically his tone and whether or not he could see, and he obviously needed some further testing, thought where to start? Of course the cell phone server was being worked on that day, so we were limited with our contacts, though I (Chris) did manage to get in touch with Dr. Judy Tapper in Kingston. She agreed that the baby needed to be seen, and didn’t want to suggest any tests until she saw the patient. Mom was very concerned about cost and had very limited resources. Dr. Tapper was very friendly and helpful, though explained that she was the only pediatric neurologist in the country of Jamaica, and therefore was very busy. If the patient wanted to go to the free clinic at Bustamante Children’s Hospital, there was a 6-9 month waiting list. She could go to Dr. Tapper’s private office, though would have to pay out of pocket for the visit (About $9500 Jamaican Dollars – roughly about $120 US) I explained all this to mom, and she understood, I told her to make the appointment at the free clinic, though stressed that if she could go to the private clinic, this would be preferred. As this was not an emergency and I had no true reason to admit the patient, these were the options. Mom understood and said she would try to figure out a way to find the money, and would make the appointment at BCH in the meantime, and would follow monthly at Peds clinic until further testing was done.
This case was interesting, though made us a bit sad, as if this boy and mom had more resources, she may get some answers a bit sooner. Hopefully it all works out and mom gets the answers and help that she needs, though at this point I’m not sure I’ll ever know how it turns out….

4 month old male who was discharged from the ward 2 weeks prior for resolved bronchiolitis. On the day prior to discharge, he developed a rash on his left leg. They were told it was probably a reaction to one of the medications (he was on Azithro and Augmentin) and gave him some diphenhydramine which did not change. The rash then spread to other parts of his body like his other leg (and soles of feet), both arms, left shoulder, and abdomen. The rash was obviously pruritic, though he was otherwise comfortable and non-toxic. The rash appeared to be in clusters, though didn’t seem to follow a dermatome or other pattern that we could identify. The lesions were mixes of papules and vesicles vs pustules? Hard to really say what it was. Mom said it seemed to be spreading slowly over the past two weeks. Any thoughts???? We were between scabies and varicella, though we’re sold on either. Our plan was to treat for scabies and have her follow in a week, or sooner if it got worse.