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QUESTION: A 17-year-old Vietnamese boy being admitted to a juvenile detection facility had linear, bruise-like lesions on his back. The possibility that he was a victim of child abuse was suspected after he claimed to have no knowledge of the cause of the bruising. Are there any other explanations for these marks?
ANSWER: The patient had symmetric linear groupings of petechiae on his back but at no other site. Initially, he claimed to have no idea about their cause. When the practice of coining (rubbing the skin firmly with the edge of a coin) was described to him, he admitted that his mother had engaged in coining him about 4 days previously. She had attempted to improve his breathing, using a method that is common in her country of origin, when she found him unconscious after an episode of illicit drug use. The young...