To the Editor.—
The recent description by Brown and Melinkovich1 of a case of Schönlein-Henoch purpura that was originally misdiagnosed as suspected child abuse, along with the accompanying color photograph, graphically illustrate an important differential feature that was not mentioned in the article.The lesions, as illustrated, are absolutely symmetrical on the cheeks, forearms, hand dorsa, thighs, and knees, producing an almost mirror image picture, left and right. The authors correctly point to the difficulty of differentiating Schönlein-Henoch purpura from traumatic skin lesions, ie, as in child abuse cases. However, the finding of perfectly symmetrical skin lesions, as in their illustrated case, must make an exogenous cause highly unlikely.
Alan Menter. Symmetrical Purpura Doesn't Mirror Child Abuse. JAMA. 1987;257(4):486. doi:10.1001/jama.1987.03390040102020