Subcutaneous Fat Necrosis as an Unusual Presentation of Child Abuse

Any unusual clinical presentation is an elaborate phenomenon that may confuse the observer. This is particularly true when the latter becomes the involved clinician facing such a phenomenon. Therefore, it is not unusual when presentations of child abuse appear disguised as conventional pathologic entities.1 A clinician's usual skills may not be enough to distinguish such cases and as such, their investigative vision requires that they look at other etiologic possibilities. Skin lesions are the most common presentation of child abuse and of these, bruises are the most common.2,3 Children with bleeding disorders and ecchymoses may be wrongly diagnosed as having been abused. Cigarette burns may become infected and may be difficult to differentiate from circular lesions of impetigo. Children with osteogenesis imperfecta are known to bruise and fracture easily.4 Intentional microwave oven burns were reported by Alexander in 1987 as an unusual manifestation of child abuse.5 One case of osteolytic lesions and medullary fat necrosis following traumatic pancreatitis was reported in 1977.6 To our knowledge, subcutaneous fat necrosis has never been reported as a form of child abuse before. As far as we know, this is the first report of confirmed child abuse in two sisters presenting with subcutaneous fat necrosis.