ABSTRACT
A 10-year-old boy is referred to the gastroenterology clinic due to poor appetite and poor weight gain. In addition to failure to thrive, his physical examination reveals an almost circumferential hyperpigmented mark around his neck as shown in Image 14a. He states his father had a family friend ‘burn’ him due to his poor appetite. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig14a.jpg"/>
What is your diagnosis?
How would you further approach this case?
32The diagnosis is maqua, which is a therapeutic burn. Maquas are small deep burns inflicted to the skin near diseased organs as part of a therapeutic process. 1 They are most often seen in the Arabic culture. A hot piece of metal or coal is usually used at the area of pain or illness. 2 In this case, the child had a poor appetite so the metal rod was heated and placed around his neck as it was thought to be the part of the body related to appetite. When further evaluated, this child was diagnosed with celiac disease. Maquas are also seen in cases of abdominal distention and recurrent abdominal pain where a hot rod is applied to the abdomen (Images 14b and 14c).
Maquas are not intentionally abusive; however, caregivers should be respectfully discouraged from using them. They are painful and may cause complications. They may also result in delay in seeking medical care and delay in proper diagnosis of diseases such as celiac disease in this child.
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