CLINICAL HISTORY.—A boy of 2 was brought to the hospital because of infections of both thumbs and forefingers. Open sores had been present from infancy, with subsequent chronic swelling and ultimately loss of considerable portions of the phalanges of these digits on both hands.
Examination showed a well-developed, well-nourished child in no distress. In addition to the findings mentioned regarding the hands, there were many old scars on the skin, and a small knobby swelling draining purulent material on several areas of the body, most notably the knees.
There was distant consanguinity of the parents. Two previous siblings had died at an early age. A film of both hands is presented (Fig 1).
Denouement and Discussion
CONGENITAL INDIFFERENCE TO PAIN
The clinical findings of scars and pustules on various parts of the body raise two possible etiologic considerations. One is unsuspected trauma (the "battered-baby syndrome"); the other, generalized sepsis. Both
GWINN JL, BARNES GR, TUCKER AS, JOHNSON C. Radiological Case of the Month. Am J Dis Child. 1966;112(6):583-584. doi:10.1001/archpedi.1966.02090150127016