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Differential Diagnosis between Child Abuse and Infantile Cortical Hyperostosis: A Case Report and Literature Review
Du-Yeon Lee1, Woo-Jong Kim1, Byungsung Kim2
1Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan-si 31151, Korea.
Insights
Early identification of child abuse is crucial. This case highlights how child abuse can mimic Caffey disease, emphasizing the need for careful clinical and radiological evaluation to distinguish between the two conditions.
Area of Science:
- Pediatrics
- Radiology
- Forensic Medicine
Background:
- Child abuse presents significant public health challenges with severe consequences.
- Accurate and timely diagnosis of child abuse can be difficult, especially in infants.
- Differential diagnosis is critical when clinical and radiological findings overlap with other conditions.
Observation:
- An 8-month-old boy exhibited extensive periosteal reactions in long bones without a clear history of trauma.
- Initial symptoms included fever, hyperostosis, and elevated inflammatory markers, suggesting Caffey disease.
- Clinical and radiological features raised suspicion for non-accidental trauma.
Findings:
- The patient was diagnosed with child abuse after thorough clinical and radiological assessment.
- Distinguishing child abuse from Caffey disease is essential for appropriate management and intervention.
- This case underscores the importance of considering non-accidental trauma in infants with unexplained bone abnormalities.
Implications:
- This case report aids in differentiating child abuse from Caffey disease, improving diagnostic accuracy.
- Enhanced awareness can lead to earlier detection and intervention for child abuse victims.
- Improved diagnostic strategies can prevent misdiagnosis and ensure appropriate care for affected children.
Abstract:
Child abuse is a major public health problem that can lead to critical consequences for the child and family. However, early identification of abuse may be difficult. An 8-month-old boy presented with extensive periosteal reaction in both upper and lower long bones. There was no specific history of injury. Caffey disease was initially considered as the diagnosis because the patient displayed fever and hyperostosis of multiple bones with elevated erythrocyte sedimentation rates and C-reactive protein and alkaline phosphatase levels. However, we suspected child abuse based on the clinical and radiological features. We eventually found out that the child had been injured through child abuse and were able to treat him. We report this case because child abuse cases may be confused with Caffey disease. This case report can, therefore, help distinguish between Caffey disease and child abuse.
