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A case of traumatic osteomyelitis in a victim of child abuse

James K Ribe1, Chanikarn Changsri

  • 1Los Angeles County Department of Coroner, CA, USA. jribe@coroner.lacounty.gov

The American Journal of Forensic Medicine and Pathology
|June 4, 2008
PubMed

Insights

This case report details a fatal infant death, initially diagnosed as pneumonia, but autopsy revealed extensive blunt force trauma and osteomyelitis, indicating child abuse. This highlights the importance of recognizing non-accidental trauma in infant deaths.

Area of Science:

  • Forensic Pathology
  • Pediatric Medicine
  • Child Abuse Research

Background:

  • A premature infant, previously healthy at discharge, was found deceased at four months of age.
  • The infant had a history of a lengthy neonatal intensive care unit stay.

Observation:

  • Autopsy revealed acute bronchopneumonia, multiple fractures (skull, ribs, fibula, radius), subdural and intracerebral hemorrhage, and retinal hemorrhages.
  • A partially healed fracture of the distal right radius exhibited a medullary abscess with pus and granulation tissue, suggesting secondary hematogenous infection.

Findings:

  • The cause of death was determined to be pneumonia secondary to multiple blunt force trauma.
  • The manner of death was ruled homicidal, with the case representing the first reported instance of osteomyelitis in the context of child abuse.

Implications:

  • This case underscores the critical need for thorough investigation in unexplained infant deaths, particularly for signs of non-accidental trauma.
  • It highlights the potential for secondary bone infections (osteomyelitis) resulting from inflicted injuries in abusive head trauma cases.
  • Forensic pathologists and pediatricians should be vigilant in identifying patterns of injury consistent with abuse, even in the absence of external signs.

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