What's causing her reaction to broccoli?

I was just sitting down to dinner when I got a frantic call from the mother of a 9-year-old girl. The child had taken a bite of broccoli and immediately began crying that her mouth hurt.

The broccoli was neither too hot nor too spicy. Both of her sisters had already eaten it with no ill effects. She had never had an adverse reaction to any food before and had no other environmental or medication allergies.

The pain was described as a severe burning sensation of the tongue and lips. Mom had tried giving water and milk to drink, with no relief. I suggested some bread, which often works better to soak up painful spicy food than liquids that merely swirl the irritant around the mouth. The girl had some bread while I was on the phone. No better.

I could hear her crying in the background. Mom said she was holding an ice pack to her lips, but she was still in pain. Her tongue didn't seem to be swollen, and she didn't seem to be having any difficulty talking or breathing. Mom was holding it together pretty well, though I could tell she was on the verge of panic.

I was just puzzled.

An allergic reaction would more likely involve itching and swelling. Besides, any allergy that began so suddenly would probably get very severe, very quickly, and it didn't sound like the child was going into anaphylaxis. And how could she get burned on food that wasn't hot?

We ruminated together on the phone for a while, but neither of us could figure it out.

"Maybe she really doesn't like broccoli, and this is her way of making sure she never has to eat it again," the mom suggested.

We both laughed. The little girl seemed a bit better, so I hung up after giving detailed instructions to keep a close eye on her for anything out of the ordinary. Then I hit my books and the Internet, still trying to figure it out.

About an hour later, the mom sent me an email.

The mother's email read:

"[My daughter] just remembered that when she was playing outside, she had picked one of the ornamental [hot!] peppers off a plant. She is not the best hand-washer, thus, the stinging when she touched her lips [same time as she was eating broccoli]. Fortunately, cruciferous vegetable will still be allowed in the house. Thanks for taking my frantic call."

I responded:

"Awesome! Don't you just love 'oh yeah' moments like that. Not only is your house still safe for broccoli, but [your little girl] has learned a valuable lesson about hand washing. Have a lovely rest of the evening."

There are many times when skin conditions on one part of the body, usually the face, are in fact caused by something originally on the hands. One of the main causes of dermatitis of the eyelids is actually products used on fingernails.

Once again, the old advice from medical school came into play: When trying to figure out a puzzling diagnosis, go back and take more history. In the hospital, that can mean looking for old records and studies, though in the office it usually means talking to the patient some more, even after they've already left the office. In fact, more often than not, that's when the extra information occurs to them. Sometimes the pressure of trying to answer a million questions while sitting in front of the doctor makes it harder to remember things.

Most medical mysteries are solved by patients themselves.

Lucy Hornstein is a family physician in Phoenixville. She blogs at http://dinosaurmusings.wordpress.com.

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