title: Perianal and vulvar Crohn's disease presenting as suspected abuse.
abstract: Misdiagnosis of sexual abuse may arise in cases of vulvar and/or perianal diseases such as lichen sclerosus et atrophicus, Behcet's syndrome, bullous diseases, contact dermatitis, or neoplastic lesions. We present the case of a 7-year-old girl who was referred by her general paediatrician to the local hospital for perianal fissures and swelling of the labia majora. A report to the judicial authorities was made, for suspected sexual abuse, and the patient was transferred to the department of paediatric surgery. Here, histopathologic examination of vulvar and rectal biopsies revealed multiple non-caseating and non-confluent epithelioid-gigantocellular granulomas, consistent with a diagnosis of Crohn's disease, with cutaneous involvement of the genitalia. In cases of suspected sexual abuse, examination of children should be performed by a specialist in legal medicine in collaboration with a gynaecologist or paediatric surgeon. If the patient is hospitalised and the question of protection does not arise, physicians should exclude dermatological diseases before reporting to the judicial authorities.
authors.affiliation: Section of Legal Medicine, Department of Environmental Medicine and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Porzionato
authors.forename: Rita
authors.initials: R
authors.lastname: Alaggio
authors.forename: Anna
authors.initials: A
authors.lastname: Aprile
mesh_terms: D001004:Anus Diseases / Q000209:etiology*; D002648:Child; D002650:Child Abuse, Sexual / Q000175:diagnosis*; D003424:Crohn Disease / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D005554:Forensic Medicine; D006098:Granulocytes / Q000473:pathology; D006101:Granuloma, Giant Cell / Q000209:etiology*; D006801:Humans; D008200:Lymphangiectasis / Q000209:etiology; D012871:Skin Diseases / Q000209:etiology; D014845:Vulvar Diseases / Q000209:etiology*