Puncture wounds and purpura.

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Date: Oct. 2021
From: Contemporary Pediatrics(Vol. 38, Issue 10)
Publisher: Intellisphere, LLC
Document Type: Article
Length: 1,297 words
Lexile Measure: 1380L

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THE CASE

You are asked to provide an urgent evaluation of asymptomatic skin lesions on the right forearm of a neurodevelopmentally impaired 6-year-old girl (Figure 1). The skin findings were first noted by a radiology nurse while the child was undergoing an outpatient MRI; the patient was referred to a pediatrician because of concern of possible child abuse.

KITTY BITES MISDIAGNOSED AS CHILD ABUSE

The lesions were apparently fresh and probably occurred that morning because the child's mother first became aware of them when the nurse inquired about the wounds. The mother reported that the family had a rambunctious 8-month-old kitten in the home that loved to play and sleep with all the family members, particularly the patient. The mother had similar lesions from a week ago, but the puncture wounds had healed, leaving flat pinpoint and surrounding ring purpura (Figure 2). The mother reported that except for the time of the bite, the lesions were not painful and healed quickly.

One week prior to discovery of the child's new lesions, the mother observed the kitten "attacking" the child's leg and causing scratches in addition to claw and bite punctures. This behavior had not previously occurred. The child was not in distress, and the lesions required no additional care. The mother obtained and placed claw caps on the kitten.

Unfortunately, at initial evaluation in the pediatric emergency department (ED), the history of the kitten as the cause of the injury was rejected, and there was concern for the injury occurring in the setting of child abuse because of the wound pattern. Specifics about what made the wound pattern concerning for abuse were not given.

The child was transferred to a children's hospital. The diagnosis of cat bite was not considered by the general pediatric staff. Two child abuse pediatricians (CAPs) rejected the mother's history of the kitten being in close contact with the child and concluded that because the wounds could not have been...

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Source Citation   

Gale Document Number: GALE|A679076291