More Than a Rash: Identifying Child Labor Trafficking in the Emergency Department, a Case Report

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ESPR106
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Abstract: :

HISTORY:

The patient is a 16-year-old Spanish-speaking male with no PMHx who presented to the ED unaccompanied with complaint of a diffuse pruritic rash. The rash was present for 30 days with symptoms waxing & waning in intensity. He had no known allergies or sick contacts. Denied new exposures, medication, drug use & sexual activity. Denied fever, cough, nausea, vomiting, or diarrhea. Endorsed being an undocumented immigrant from Central America. He was smuggled into the US six months ago & stated he was residing with a group of men, none of which his legal guardian. He notes that he is indebted to his smuggler. Patient does not attend school but works handing out pamphlets and magazines to pay off his debt. He endorsed waiting on street corners for work.

PHYSICAL EXAMINATION:

Vitals: Temp 36C (96.8F), HR 79 BMP, BP 125/58, RR 24, SpO2 100% on RA

PE: Widespread diffuse papulo-follicular rash most significant on back, bilateral arms and cheeks. Rash was blanching, non-sloughing & spared palms, soles & mucosa. Front teeth were absent, dentures in place. Remainder of the physical exam was WNL.

LABS/IMAGING/PROCEDURES:

Basic lab testing was sent was well as HIV, RPR, Hepatitis panel. Urine was sent for Gonorrhea and chlamydia. All results were WNL. STI testing was negative.

FINAL DIAGNOSIS & DISCUSSION:

Patient was treated with Benadryl, systemic & topical steroids. There was significant improvement of the rash within 24hrs, making the diagnosis consistent with auto-eczematization/ID reaction with unknown trigger.

Given the patient was an unaccompanied minor as well as the reports of his living & working situations, concern was raised for labor trafficking. CPS was contacted & the Child Abuse Pediatrician was consulted. Investigation revealed that the patient was actually residing with his mother & step-father, fear of deportation made him reluctant to disclose their residence in the US.

This case highlights the importance of recognizing the potential signs of labor trafficking in minors in an acute care setting. There are various possible contributors to minor labor trafficking (Figure 1). Examples of instances when medical professionals should consider labor trafficking can be found in Table 1. Once recognized, it is important to respond & report such cases appropriately. It is estimated that only a minute percentage of US medical centers have established protocols for identifying & reporting cases of suspected labor trafficking. Increased education, awareness & guidance of medical professionals is necessary to better identify & assist minor victims of labor trafficking.

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Staten Island University Hospital - Northwell Health
Staten Island University Hospital

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