[Vulvar lichen sclerosus in children misdiagnosed as sexual abuse]. / Lichen scléro-arophique vulvaire chez l'enfant : diagnostic différentiel d'abus sexuel.

INTRODUCTION: With the frequency of lawsuits for sexual abuse increasing, high-quality care for victims is of utmost importance. Genital examination is difficult to perform, especially on children, but is a key item for diagnosis. A case report is presented herein to illustrate this issue. CASE PRESENTATION: A sexual assault was suspected on 2.5-year-old female twins. Clinical examination primarily detected vulvar micro-hematoma and hypopigmentation, discreetly sclerosing, as well as atrophic labia and a beginning of lichenification on one of them. The other twin showed an unspecific and erythematous lesion. Elimination of the supposedly dangerous environment and a remote consultation brought out a paradoxical development to the story and confirmed the diagnosis of vulvar lichen sclerosus. DISCUSSION: Traumatic lesions caused by sexual abuse are uncommon. Coexisting allegations and lesions in the genital area lend support to the hypothesis of sexual abuse. However, genital-anal tropism dermatosis can mimic traumatic injuries. Lichen sclerosus is an example of a differential diagnosis of vulvar traumatic lesions, which is quite often unknown to physicians, including pediatricians. This case report shows that taking the appropriate time in multidisciplinary councils can suggest a differential diagnosis. Nonetheless, it should be remembered that identifying the pathology behind the lesions cannot allow the physician to negate the child's story about potentially sexual acts, although the truth of this story and the perpetrator must still be proven by a court of law.

Liability under post-tonsillectomy lethal bleeding of the tonsillar artery: a report of two cases.

Post-operative haemorrhage is a frequent complication of tonsillectomy: a primary haemorrhage occurring in the first hours is rapidly dealt with by the surgical team. A secondary haemorrhage, which commonly occurs once the child has returned home, can be fatal if it is not dealt with quickly. We present two cases of a lethal outcome in children following a secondary post-tonsillectomy haemorrhage, for which the parents filed legal proceedings. Medical liability can be exercised during all stages of health care. Performing an autopsy associated with histological analyses is found to be indispensable for the identification of the causes of bleeding, as well as its mechanism.