ABSTRACT

A 3-year-old is brought into accident and emergency on a Monday morning because she has developed several bruises on her buttocks, left leg and right arm. She is seen with her nanny who reports finding the bruises when she was getting her dressed this morning. Recently the girl has not been herself. She has had several colds over the past 2 months and has been more lethargic lately. The nanny is worried she is losing weight. On examination she appears withdrawn, pale and has a bruise on the left buttock which is 5 cm × 8 cm. She has three other bruises on her left leg and right arm which are of varying colours. She also has some fine petechiae on her neck and cheeks. She has a runny nose and a cough but the chest is clear. What is the most likely diagnosis?