Dr Kempe's marginal comment in the November 1975 issue prompts reference to another example of an unusual manifestation of injury related to child abuse. A previous report of this case emphasized the relationship between pancreatitis and lytic bone lesions, without particular attention to its resulting from child abuse.1
Report of a Case.—A 3½-year-old girl was brought to the emergency room semiconscious by her father who alleged that she had bumped her face on the dashboard of his car when he had stopped the car suddenly in traffic. The entire left side of her face was deeply ecchymotic, and her left eye was swollen shut. She appeared semiconscious, but responded to stimulation and verbal instruction.
Other acute findings were ecchymoses of the back and abdomen, hypotension, oliguria, proteinuria, microscopic hematuria, pyuria, metabolic acidosis, gastrointestinal bleeding, azotemia (blood urea nitrogen, 60 mg/100 ml), hypocalcemia with seizures (serum calcium, 6.7 mg/100