ABSTRACT
A 6-year-old boy was brought to your office after he was removed from his parents’ care. He and other children were found unattended in a filthy apartment and police noticed he appeared dirty, with poor hygiene and rashes on his arms. During physical examination in the emergency room, a physician became concerned about additional lesions noted over his back and buttocks as shown in Image 106. You were asked to determine whether these were bruises and what additional evaluation is needed.
What does the image show?
Are these lesions bruises?
What additional evaluation is needed? https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig106.jpg"/>
242This child demonstrated several irregularly shaped blue/purple lesions which were homogeneous and extended over the lower back onto the buttocks and sacrum. There were no ecchymotic areas or pattern marks which would suggest bruises.
These lesions were not bruises. They are commonly called ‘Mongolian spots’ or ‘Mongolian blue spots’ and they are more properly called congenital dermal melanocytosis. 1 They are present from birth, generally fade during the early years, are more prominent among dark-skinned individuals and may persist into adulthood. They are superficial and, while often seen in this area, may also be seen on the abdomen, extremities and other areas.
Nutritional and developmental assessments would be helpful given the reported chronic neglect to determine if special education services or therapy (physical, occupational, speech) are needed. The statewide registry for immunizations should be checked as well as any available medical records to determine if he had any underlying chronic diseases needing treatment. Children with neglect may also have exposure to environmental lead and anaemia, and screening tests for red blood count and serum lead level are indicated.
