ing child in no distress with a blood pressure of 112/64 mm Hg; pulse, 80/min; respirations, 18/min; and temperature, 36.7 C. Abnormal physical findings w e r e

limited to the left knee. The knee displayed a moder- ate effusion, warmth, but no ligamentous instability or joint line tenderness. The cell count showed the fol- lowing: hemoglobin 12.8 g/dl, and WBC count 7,400/cu mm with 54% polymorphonuclear leukocytes, 1% bands, 31% lymphocytes, 11% monocytes, and 3% eo- sinophils. Sedimentation rate was normal and the sickle cell preparation was negative. Radiographs of the involved knee revealed no bony abnormalities. Arthrocentesis obtained 20 cc of slightly turbid am- ber-colored fluid. Analysis of the fluid showed the fol- lowing: glucose 41 mg/D; protgin 5.6 mg/dL; Gram stain negative for Organisms; and WBC count, 29,800/ cu mm with 1% polymorphonuclear leukocytes, 38% eosinophils, and 61% mononuclear lymphocytes.

The child was admitted to a nearby hospital. The following day the child passed a large Ascaris per rec- turn. Subsequent stool examination revealed both A lumbricoides and Trichura trichuris. The patient was treated with mebendazole. The effusion did not reac- cumulate.

The association of an eosinophilic joint effusion with intestinal nematodiasis had not been seen by our rheumatologic, orthopedic, or gastrointestinal consul- tants. The temporal association of the effusion and the infestation suggests the localized eosinophilia was re- lated to the nematodiasis.

Paul J. Treusch, MD Robert E. Swetnam, DO Bradford J. Woelke, MD

Providence Hospital Southfield, Michigan

Ethyl Chloride for Degreasing To the Editor:

The purpose of this letter is to report the value of ethyl chloride as a reliable and safe degreasing agent.

Dirty injuries, such as lawn mower injuries in children, are difficult to clean because of the pain in- duced by most degreasing agents. A simple, readily

available degreasing agent is ethyl chloride. We have used ethyl chloride in more than 100

children. Ethyl chloride proved to be an excellent de- greasing agent. Not only did we see no complication with the use of ethyl chloride in these children, but the process was painless.

For the Sake of patients with dirty, greasy in- juries, we hope ethy ! chloride becomes widely used as a degreasing agent.

Fernando J. deCastro, MD, MPH Professor of Pediatrics-Adolescent Medicine

Director of Ambulatory Services -- Emergency Department, Cardinal Glennon

Memorial Hospital for Children St. Louis University Medical Center

St. Louis, Missouri

Previously Unreported Side Effect of Parafon Forte ®

To the Editor:

Parafon Forte ® is a combination drug consisting of chlorzoxazone 250 mg and acetaminophen 300 mg per tablet. Chlorzoxazone has been frequently pre- scribed and is classified as a possibly effective, cen- trally active muscle relaxant.

Recently, a 24-year-old white man presented with opisthotonis and torticollis. He admitted only to inges- tion of six tablets of Parafon Forte ® over the preceding 12 hours. There was no previous psychiatric or drug abuse history. The patient was treated with BenadrylV 50 mg IV with moderate improvement. After 15 min- utes administration of benztropine mesylate, 2 mg IV, led to full recovery within five minutes. A blood and urine toxicology screen was negat ive for pheno- thiazine and butyrophenones. This would appear to demonstrate a previously unreported and serious side effect of a "possibly" effective drug.

Ralph Badanowski, MD James W. Powell, MD

Department of Emergency Medicine St. Vincent's Medical Center

Jacksonville, Florida

10:11 (November) 1981 Ann Emerg Med 615/lO9