Infantile cortical hyperostosis (Caffey disease): a possible misdiagnosis as physical abuse

Area of Science:

• Pediatric Radiology
• Pediatric Orthopedics
• Neonatal Medicine

Background:

• Infantile cortical hyperostosis, also known as Caffey disease, is a rare inflammatory bone disorder affecting infants.
• It is characterized by bone swelling, often in the long bones and mandible, and typically resolves on its own.

Observation:

• A case report of a 1-month-old Chinese boy presenting with bilateral shin swelling.
• Initial suspicion of physical abuse due to the presentation.
• Radiological evidence included periosteal thickening, symmetrical diaphyseal involvement, and epiphyseal sparing.

Findings:

• The radiological pattern strongly suggested Caffey disease over physical abuse.
• Key diagnostic features include symmetrical, diaphyseal periosteal reactions sparing the epiphyses.
• Mandibular involvement is also a characteristic finding.

Implications:

• This case underscores the importance of considering Caffey disease in infants with suspected non-accidental trauma.
• High index of suspicion is needed to avoid misdiagnosis and unnecessary interventions.
• Accurate diagnosis prevents potential harm from misinterpreting benign infantile cortical hyperostosis as abuse.