Differential Diagnosis: Child Abuse
The differential diagnosis of skin discoloration in children includes child abuse as well as accidental injury, hematologic diseases, and congenital skin lesions. A seven-month-old boy from a Turkish family was brought to the hospital because of the suspicion that he had been beaten by his father. The forensic medical examination revealed poorly demarcated, homogeneous, bluish discolorations of the skin, of varying sizes, on the back and buttocks. On re-examination five days later, the appearance of the lesions was unchanged and a definitive diagnosis of Mongolian spots was made.
Mongolian spots are benign congenital pigmentary lesions that are common in some ethnic groups. They are usually located on the buttocks, and they disappear by puberty. Although it is clearly important that a diagnosis of child abuse should never be missed, the formulation of a differential diagnosis is important as well, so that misinterpretations with unfortunate legal consequences can be avoided. In case of uncertainty, a follow-up examination after an adequate period of time is recommended so that the evolution in color associated with true traumatic hematomata (bruises) can be observed or ruled out.
Dr. med. Benjamin Ondruschka, Dr. med. Christian König
Institut für Rechtsmedizin, Universität Leipzig, firstname.lastname@example.org
Conflict of interest statement: The authors state that they have no conflict of interest.
Translated from the original German by Ethan Taub, M.D.
Cite this as:
Ondruschka B, König C: Differential diagnosis: child abuse. Dtsch Arztebl Int 2017; 114: 270. DOI: 10.3238/arztebl.2017.0270