Background: Medical child abuse is a challenging diagnosis to make, particularly in older children with unusual presenting symptoms.
Case: A 7-year-old child with complex medical history presented with anogenital bleeding of unknown origin. Extensive laboratory testing, imaging studies, and diagnostic procedures were negative for any etiology. Forensic testing confirmed the blood in her underwear was a genetic match to the patient. Trial separation from the mother was diagnostic and therapeutic in this case.
Summary and conclusion: Older children who are victims of medical child abuse might present in a variety of ways, and might even collaborate with the perpetrator in falsifying symptoms. It is important to keep medical child abuse on the differential when the patient's symptoms and work-up do not match.
Keywords: Genital bleeding; Medical child abuse; Munchausen by proxy; Pediatric; Vaginal bleeding.
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