THE SYNDROMEMain manifestations. Migratory ichthyosiform rash, cleft palate, hypertelorism, bilateral retinal colobomata, large size, seizure disorder, and developmental delay.Prenatal history. Maternal work exposure to aflatoxin assay (aflatoxin, chloroform, toluene, and benzene) during first 4-6 weeks of gestation.Birth history. Forceps delivery without further complications. BW was 4.0 kg (95%), TBL was 53.5 cm (95%).Medical/surgical history. Appearance of ichthyosiform rash by 1 week. Onset of seizures at 9 months, aggravated by high environmental temperatures. Repair of cleft palate at 15 months.Family history. G2P1, 23-year-old Irish-Dutch mother and 26-year-old Polish father. No known relatives with similar or other birth defects. Healthy 4lh-year-old sister.Clinical examination at 3% years. Male. height 101.5 cm (90%), weight 18.6 kg (>95%), OFC 48.5 cm (5%). Inner canthal, outer canthal, and interpupillary distances > 97 % .Skin and hair (Fig. I). Large areas erythematous, ichthyotic plaques with sharp margins. Palms and soles thickened. Uninvolved areas of skin normal. Fine, sparse, blond hair in normal distribution.Head and face (Fig. 2). Brachycephaly. Epicanthal folds. Left ptosis and exotropia. Bilateral retinal colobomata. Flat nasal bridge with linear scar-like tissue
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