Pt is a 34 month old male that has been potty trained for about 5 months. Mother states the pt went to bed the previous evening c/o severely upset stomach. During the night he supposedly had a large, fowl smelling, incontinent diarrhea stool at about 1:00. This was followed by another that was discovered at about 07:00. When mother removed the pts underclothes she says she saw large blisters, some of which had burst and had the covering skin peeling off.
The pt was admitted to my unit at about 18:00 on the weekend. The affected area ran from the base of the scrotum up to the coccyx. It was about 11cm wide at the buttocks and narrowed at it went up the gluetal fold to about 4-5cm. Only the very lower tip of the scrotum was affected and had a <1cm round blister.
Here is the catch: the area right around the anus and inside the gluetal fold was only slightly red to normal in color. In fact, the center area of the buttocks (where most of the pt's weight would rest) was basically normal. But the blistered area had blisters as big as 1cm by 3 cm. One of the areas where a blister had burst and the skin pealed was an oval area of 2cm x 4 cm. (Boy, I wish I could post pictures of this.)
Judging by the shape of the affected area and the severity of the burned skin, I believe the child was laying in a caustic fluid for a long period of time.
At this time CPS have removed the pt and a sibling and placed them in foster care. I was told that they were even looking into criminal charges against the mother.
Now I am normally the one on the unit that is first to bring up the topic of calling CPS. I have even ****** off a couple of MDs by doing this myself when they felt it was not necessary. BUT I do not think this is abuse! Not this time. I think it was not a deliberate injury because of the shape of the affected area and what parts of the area show the most injury.
Have any of you ever had to deal with a case where a child had large blisters on the bottom when it was NOT abuse and what causes it?
What, if any action do you think I should take?
Do any of you know of a source where I can get pictures of burns in the same area where you would expect a bad diaper rash?
My nephew got a diaper rash similar to that when we were visiting them. It was awful looking and appeared within hours. It involved large blisters that popped and peeling skin rash around it. I have never seen anything like this before or since. He had a normal looking rash that developed into this. He had also developed some diarrhea on the last day of our trip (fun times!). I had changed him before our flight and noted a severe looking rash. They had bought a different brand of diapers for the trip and he was probably reacting to it. But it looked nothing like what appeared after he started screaming about halfway through the flight. We changed it mid-flight and found it had developed suddenly into the blisters. The ped said it was a type of staph infection. It was treated appropriately with both oral and topical antibiotics and he got a lot better.
Here is a website with several examples of the staphylococcal scalded skin syndrome
Last edit by anon456 on Feb 20, '14
: Reason: adding link