A 14-year-old boy presented to the abuse clinic at the request of Child Protective Services (CPS). According to CPS, the boy’s gym teacher had noticed multiple large bruises on his back, arms, and legs. School officials had previous experience with the child’s “volatile” stepfather and thought him “capable of abuse.” There were also unofficial concerns of past domestic abuse per the CPS history.
The boy had been interviewed at school by teachers and CPS and had repeatedly denied any abuse. He alleged a very good relationship with his stepfather, and denied any form of trauma.
The boy’s family came to the abuse clinic without any pressure from CPS. They seemed more concerned about the child’s health and safety than any possible allegations being leveled at them. The parents provided a complete medical history while the boy was interviewed by a social worker. The family stated that the teen was very private and that they had not seen his bruises until the school called. The stepfather had been in the family for 12 years. While the boy was examined and the final aspects of the medical history were obtained, the family was interviewed by the social worker.
All the histories were consistent with one another. The history of volatility and domestic abuse was not verified by cursory investigation by law enforcement.
The medical history revealed that the boy had a viral infection in the past 2 to 3 weeks. The physical exam revealed 11 large bruises (Figure). There was no specific pattern or uniformity to the bruises. The boy was private and would only consent to our taking a picture of his arm. The abdominal exam was compatible with an enlarged spleen (3 cm below the costal margin).
After a meeting of the abuse clinic staff, CPS, and law enforcement before discharging the boy, all agreed on the diagnosis.
Was this physical abuse—or a mimic?
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