This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations and discussions.
Case 1 Presentation
A 4-year-old boy is brought to the office because of bruising that his mother had noticed while bathing him 2 days previously. He has not had nosebleeds or noticeable blood in his stool or urine, and he has been well except for a bout of gastroenteritis 2 weeks earlier. His parents are separated, and his mother states that the youngster's father spanked and kicked him and his brother during a visit last weekend. An 11-year-old sister is present and says that the father grabbed the boy's arm and "kicked his rear with his boot."
On examination, the child has multiple bruises—some appearing fresh, some apparently several days old—on his back, anterior torso, arms, and anterior thighs.