Differential Diagnosis between Child Abuse and Infantile Cortical Hyperostosis: A Case Report and Literature Review.

Du-Yeon Lee,Chang-Hwa Hong,Ki-Jin Jung,Changeui Lee,Ik-Dong Yoo,Jae-Hwi Nho,Byungsung Kim,Woo-Jong Kim,Sang-Mi Lee

doi:10.3390/ijerph182212269

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.

Highlights

The important role of the orthopedic specialist is emphasized in a mini review by Pavone et al health care providers should be familiar with signs of child maltreatment and the medical conditions that may mimic child abuse
Caffey disease may resemble a fracture with cortical hyperostosis and should be ruled out along with a few other metabolic diseases, prior to determining a diagnosis of child abuse
The Child Abuse Prevention and Treatment Act defines the maltreatment of a child as “any recent act or failure to act on the part of a parent or caretaker, which results in death, serious physical or emotional harm, sexual abuse or exploitation, which presents an imminent risk of serious harm”

Summary

Background

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. This study was published to highlight the importance of the differential diagnosis between Caffey disease and child abuse. Caffey disease may resemble a fracture with cortical hyperostosis and should be ruled out along with a few other metabolic diseases, prior to determining a diagnosis of child abuse. In a prospective observational study of 2890 children undergoing evaluation for physical abuse, only 19 children had metabolic bone disease including vitamin D deficiency, osteoporosis, hyperparathyroidism, and Menkes syndrome [5]. Children with metabolic bone disease may have pathological fractures induced by minor trauma, which may seem trivial compared to the skeletal injuries of abused children. We report a child abuse case with multiple fractures serious enough to suspect a systemic condition such as Caffey disease

Case Description

Infantogram

Findings

Discussion

Conclusions