The Story of Pacific’s Diagnosis
This is the story of how Pax was diagnosed with xeroderma pigmentosum, and the events leading up to it. There are some graphic pictures from his time in the hospital, and you may not want to read this post if you would be sensitive to viewing those.
Pax was a healthy baby. He was born a few weeks early, October 10, 2012, but had no medical issues in his first months of life. With his fall birthday, he had little exposure to the sun, since it was too chilly to take a newborn outside much through the winter.
In March of 2013, I took Pax and his two sisters on a trip to visit friends in the San Francisco Bay area. We went by train and got there early the morning of March 22. The next day, we went to the park in the afternoon. It was a perfect temperature- not too hot, not too cold. We spread out blankets in the shade for the babies while the older kids played. As sun kept ducking behind some clouds, we moved out of the shade to be a little warmer. I hadn’t brought sunscreen on our outing, so I just used the shade from my body to keep him out of the direct light for the most part. He was out in the sunshine for about half an hour total.
We noticed some redness and then swelling over the next 24 hours. We thought at first it might be a bug bite, since the swelling was mostly under one eye. A little over 24 hours later, one eye was almost swelled shut and the other was swelling as well. The nurse helpline from his insurance finally said we should take him in, and I rented a car and drove an hour and a half to Sutter General Hospital in Sacramento, where insurance told us was the closest place he would be covered.
We got to the hospital around midnight and were taken to a triage room. A medical assistant quickly looked at him, chastised me for not having a hat and sunscreen on him, and sent us home, telling us to just put aloe on his burns. I asked repeatedly to be seen by a doctor, but they wouldn’t do so.
The next two days were miserable. Pacific was in constant pain, and would only sleep in fits and start while being bounced. Children’s Tylenol did little for the pain. The swelling and weeping spread, and where the fluid dried, his skin would peel off. I kept in touch with his pediatrician’s office in Seattle over the phone, but since he had already been seen in an ER and determined to not be in need of treatment, they didn’t have me bring him back in.
Finally on Wednesday, March 27, the insurance nurse help line gave approval for me to take him in again. He hadn’t had any wet diapers in over 8 hours and was severely dehydrated. This time they sent me to San Francisco General Hospital, an hour close to where I was staying in Berkeley. Upon seeing him, they sent us upstairs immediately and they started him on IV fluids and morphine. He was admitted for the night, and slept restlessly in my arms while the IV rehydrated him and attempted to keep his pain under control. Whenever his pain would spike, he would have issues with tachycardia, and they kept him on a heart monitor.
The next day, they finally seemed to find a pain med combo that worked for him, and started to be awake and alert that evening. When it became clear that we wouldn’t be leaving the hospital anytime soon, my partner and my girlfriend drove the 14 hours down from Seattle to be with us and arrived Friday morning. He was having longer periods of being awake by then, and they began weaning him off of his IV fluids.
We were discharged on Saturday afternoon, almost exactly a week after his initial burns. We took a few hours to pack up, then drove through the night to get home to Seattle, since he couldn’t be exposed to any sunlight, even on the car ride.
We arrived home late Sunday morning and all fell asleep for several hours. When we woke up, we found that Pax had spiked a temperature of 102.8, so we went to the Emergency Room at Seattle Children’s Hospital. His temp reached as high as 103.8 before meds brought it down finally.
The main concern was a blood infection from the burn site. They admitted us to the hospital and began running tests. They collected urine to test for porphyria, another condition that causes severe sun sensitivity, and sent that off to a lab in Texas. Labs eventually showed that his fever was due to RSV, which he had likely picked up during his hospital stay in San Francisco, and a UTI, which we believe he likely contracted during his catheterization. Because UTIs are rare in infant boys, they did an ultrasound where it was discovered that he has a duplex left kidney, a relatively common and minor defect. We spent two nights at Seattle Children’s Hospital before being discharged.
The next week was spent at home keeping him isolated while his immune system was compromised. We found out on April 5 that the tests for porphyria had come back negative, which left the scariest of the potential diagnoses remaining.
On April 9, the day before Pacific turned 6 months old, I received a phone call from the National Institutes for Health. Tests had ruled out all other diagnoses that would cause the severe burns he had experienced. They were giving us a presumptive diagnosis of xeroderma pigmentosum. I spent about an hour on that initial phone call, trying to absorb as much information as I could. A few weeks later, they took a skin biopsy and sent that with blood samples to NiH for genetic testing. That may be able to confirm the diagnosis, but because this disease is so rare and there are multiple forms of it, it is possible that genetic confirmation may not be possible.
We have been lucky in many ways. We learned of Pacific’s condition before he had much sun exposure, and because of that we are able to modify his environment to keep him protected from UV, giving him a good chance of living a long life.