Case Presentation : An Otherwise Healthy 9 Month Old Boy

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Case Presentation: An otherwise healthy 9-month-old boy was brought to the Emergency Department by respite foster parents with a chief complaint of unusual bruises and marks on his skin. Two days prior to the ER visit, the respite foster parents had noticed some left eye redness and swelling, which by day of presentation had progressed to a large swollen blue-black lesion on his left cheek and new scattered bluish lesions on his thighs. The child had been diagnosed with a viral upper respiratory illness three weeks prior and had some lingering nasal congestion with tactile temperatures for the past week, but was otherwise acting very well, eating normally, and was not fussy. His past medical history is remarkable for a pre-term birth at 31 and 5/7 weeks gestation via vaginal delivery. The biological mother’s pregnancy was complicated by premature prolonged rupture of membranes and polysubstance abuse. He was not on any medications and has no known allergies. On physical examination in the ED, his vital signs are within normal limits for age. He is well-appearing and in no acute distress. Head and neck examinations are within normal limits with a soft and open anterior fontanelle. Cardiovascular, pulmonary and abdominal examinations also yield no abnormalities. Skin findings include an obvious large targetoid ecchymosis with underlying edema on the left cheek, a right posterior auricular ecchymosis, as well as several scattered annular blue-black ecchymoses on the bilateral

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