The family recently moved to Houston from Mexico. There was no history of travel to other areas, or of known exposure to infections or toxic substances. Subsequently, phenobarbital and fosphenytoin were discontinued because of the appearance of a rash, and treatment with valproic acid was initiated. Normal skin pigmentation in areas uninvolved by rash. No dysmorphic facial features.
Funduscopic exam reveals sharp disks with no hemorrhages.
Clear to auscultation bilaterally. Regular rate and rhythm, no murmurs. Normal bowel sounds. Normal male genitalia. Withdraws to painful stimuli sluggishly in the four extremities.