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The U.S. Environmental Protection Agency - Region III (EPA) provided the Agency for Toxic Substances and Disease Registry (ATSDR) with (1) environmental contamination data for a private residence and (2) medical history information for a 13 year-old male occupant of the house. The EPA asked ATSDR to review the information provided and determine whether environmental contamination could contribute to the boy's medical condition.

In March 1998, the boy's mother turned on a ventless gas log fireplace, which burned throughout the night. The next morning, the mother reported finding a gray dust or soot material throughout the house. Since the boy started experiencing medical problems shortly after this incident, health officials have questioned whether the boy's medical condition could be related to chemical emissions from the fireplace.

Medical History

The patient is a 13 year-old boy who presented to the Bluefield Regional Medical Center on April 4, 1998 with shortness of breath and cyanosis. According to his mother, the patient was previously treated with Bactrim for three weeks for otitis media. He subsequently developed high grade fever, confusion, gray skin color, and dyspnea. At that time, the patient was seen in the emergency room and was diagnosed with sinusitis and bronchitis. He was given a Cephalosporin antibiotic and discharged on Augmentin. His private physician latter changed his antibiotic to Cefaclor.

The patient's past medical, surgical, birth, family, and social histories were not unusual. According to his Discharge Summary from the Bluefield Medical Center, "There was a questionable (sic) of allergy to Bactrim." The patient was found to be in acute respiratory failure and was admitted to the Intensive Care Unit with a diagnosis of pneumonia. The next day, his chest x-ray showed a diffuse pattern suggestive of Acute Respiratory Distress Syndrome (ARDS).

The patient was transferred to the University of Virginia (UVA) Hospital where a diagnosis of chronic eosinophilic pneumonia was confirmed by lung biopsy. The patient was subsequently treated with steroids for two months and transferred back to the original hospital after some improvement. However, his lungs continued to deteriorate. Slides from a lung biopsy were reviewed at Johns Hopkins Hospital, and no asbestos or similar fibers were found. X-rays done at UVA Hospital revealed honey-comb patterns in the lower lobes, suggestive of eosinophilic granuloma. However, a second biopsy to confirm the diagnosis was deferred because of the high risks involved.

The patient returned home in July 1998 and made weekly visits to the UVA Hospital for routine blood and pulmonary function tests. After he returned home, his condition worsened. During the week of July 27, 1998, the patient was moved from the house because his physicians felt that something in the house might be the source of his worsening condition.

Since then, the patient's condition has improved, and he returned to the house in October 1998. His physician is continuing to monitor his condition with periodic blood and pulmonary function tests.

Environmental Testing

In August of 1998, representatives of the EPA collected the following environmental samples at the residence and analyzed them for chemical contamination: (1) A total of nine air samples were collected from the living room, dining room, and the boy's bedroom. The samples were collected with the fireplace burning or off, with the heat pump on or off, and with the living room open or enclosed in plastic sheeting. The air samples were analyzed for asbestos fibers with transmission electron microscopy. (2) A piece of the filter from the cold air return duct and a piece of new filter were analyzed for metals and semi-volatile organic chemicals. (3) Air samples from the living room and the boy's bedroom were collected with Summa canisters while the fireplace was burning and analyzed for volatile organic chemicals. (4) A sample of the fireplace log set was analyzed for fibers.

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