Misinterpetration of Osteogenesis Imperfecta to Child Abuse : A Dramatic Impact for The Family Accused. Case Report and Literature Review

Abstract

One of the most common causes of infants who are hospitalized with unexplained fractures is child abuse. It is found equally in all racial and socioeconomic groups. It has been infrequently reported that the actual underlyingcause of fracture is bone disease. Osteogenesis imperfecta (OI), the most common genetic cause of osteoporosis, is the major problem that misleads to child abuse.This report reveals an 8-month infant of Thai nationality who has bone fractures with minor trauma in daily activities. No other abnormalities of history, physical or radiological examination make misinterpretation at first admission to child abuse.The dramatic impact for the family accused came after diagnosis because we need to separate the patient from his parents to avoid repeated abuse. Finally, disordersof OI disease began to be seen more clearly and the new fractures occurred after patient was moved to protected environment. Thus, the real cause of  nexplained fractures in this patient is OI. It is recommended that OI should be a differential diagnosis from child abuse presenting with fracture. Both OI and child abuse have no pathognomonic signs and some types of OI may not show any abnormal symptoms which makes diagnosis more difficult. In cases diagnosis are complicated we should rely on extensive laboratory investigation to prevent erroneous diagnosis of bone disease from child abuse.