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Images in paediatrics
Non-accidental injury or congenital infection?
  1. Anne-Laure Hérissé1,
  2. Christine Chiaverini1,2,
  3. Thomas Hubiche3,
  4. Antoine Tran1,
  5. Jennifer Rondel4,
  6. Olivier Rosello5,
  7. Lisa Giovannini-Chami4,
  8. Hervé Haas1
  1. 1 Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
  2. 2 Dermatology Department, CHU L'Archet2, Nice, France
  3. 3 Dermatology Department, Hôpital Bonnet, CHI Frejus Saint Raphaël, France
  4. 4 Paediatrics Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
  5. 5 Paediatric Orthopedics Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France
  1. Correspondence to Dr Anne-Laure Hérissé, Paediatric Emergency Department, Hôpitaux Pédiatriques de Nice CHU-Lenval, 57 Avenue de la Californie, Nice 06200, France; annelaure.herisse{at}gmail.com

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A 5-week-old infant was referred with discomfort and poor weight gain. Clinical examination showed malnutrition, fever, right-elbow swelling and recent erythematosus plaques with palmoplantar lesions. Non-accidental injury (NAI) was suspected after a right-elbow fracture was identified. A skeletal survey highlighted multiple fractures, with destruction of the medial metaphyses of both humeri, ulnae, radii and tibias, and diffuses periosteal reactions (figure 1A–C). Blood tests showed 150 mg/L C reactive protein and a leucocyte count of 22 000/mm3. The infant was treated with cefotaxime and gentamicin. The presence of a …

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