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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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