Aims: Non accidental injury (NAI) is defined as any abuse inflicted on a person or knowingly not prevented by a care giver. The injury is not consistent with the account of its occurrence. We describe an unusual case that presented with symptoms suggesting immunodeficiency with significant initial diagnostic dilemma.
Methods: Clinical data, laboratory and radiological records of our case were reviewed.
Results: A 15 month old girl presented with alopecia, recurrent infections comprising left dacryocystitis with subsequent preseptal cellulitis, left maxilla zygomatic abscess and left suppurative otitis media occurring within the preceding 3 months. She also had several episodes of swelling and bruising in various body parts. There was an initial strong suspicion of an underlying immunodeficiency or autoimmune disorder. She was reviewed extensively by multiple disciplines with a battery of blood investigations which was not in keeping with either. Chest radiograph was normal but surprisingly revealed fractures of both proximal humeral metaphyses beyond the field of focus. Further radiological investigations including skeletal surveys showed multiple healing fractures without evident osteopenia. These events in retrospect were closely linked to the period of care by a close care giver. She made an excellent recovery evident on 5 months follow up. She is well known to child protection services.
Conclusion: The diagnosis of NAI is complex; this will ultimately depend upon evidence collected from all agencies involved in the care of the child. The thorough investigation of children with suspected NAI is critical to assure their safety.