Child abuse may be seen with a broad array of signs and symptoms.1,2 Some cases are easily recognized, with one or more of the now classic historical and physical features of this condition. Others come to attention only after more subtle findings lead to consideration of the diagnosis. Some cases, unfortunately, escape recognition and are not identified as instances of child abuse, leading to incomplete diagnosis and possibly inappropriate treatment and follow-up.

Our purpose in reporting this case is to alert health professionals to an unusual manifestation of child abuse.


The patient, A.R., was an 8-month old girl who had, according to her parents, manifested symptoms of an upper respiratory infection for a week prior to her admission to hospital.

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