Toddler with unexplained multiple bruises

Area of Science:

• Pediatrics
• Hematology
• Clinical Diagnosis

Background:

• Distinguishing between accidental, intentional, and pathological causes of bruising in children presents a diagnostic challenge.
• Extensive bruising in pediatric patients necessitates a comprehensive differential diagnosis, including non-accidental trauma and underlying medical conditions.

Observation:

• A 17-month-old healthy male presented with multiple unexplained bruises following an unwitnessed fall.
• Initial assessment was complicated by the unwitnessed nature of the fall and the extent of bruising.

Findings:

• The child was diagnosed with a congenital vitamin K-dependent clotting factor deficiency.
• This diagnosis explained the unexplained bruising without evidence of trauma or abuse.

Implications:

• This case underscores the critical importance of a thorough clinical assessment in evaluating pediatric bruising.
• Recognizing rare bleeding disorders like congenital vitamin K-dependent clotting factor deficiency is crucial for appropriate management and to avoid misdiagnosis of abuse.
• Early identification of bleeding disorders can guide specific diagnostic workups and prevent serious complications.