@article{ref1,
title="Morphologic markers of acute and chronic stress in child abuse",
journal="American journal of clinical pathology",
year="2021",
author="Flomenbaum, Mark A. and Warner, Ryan C.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="OBJECTIVES: To elucidate pathologic markers of acute and chronic stress found but rarely reported in chronic child abuse. <br><br>METHODS: Autopsies of 3 cases of fatal child abuse with well-documented chronic maltreatment are reported, with an emphasis on the nontraumatic findings of acute and chronic stress. <br><br>RESULTS: Besides the overwhelming physical injuries, all 3 children and 1 additional case obtained for consultation had telogen effluvium, a form of alopecia well known to be associated with stress in adults and some children but never reported in chronic abuse. All 3 had the microscopic findings of markedly involuted thymus, a well-known marker of physiologic stress in children but only occasionally referred to in child abuse. All 3 also had microscopic findings of myocardial necrosis associated with supraphysiologic levels of catecholamine, a well-documented finding associated with stress but rarely reported in fatalities associated with child abuse. Two of the 3 children also had Anitschkow-like nuclear changes in cardiac tissue, markers associated with prior, nonischemic myocardial pathologies that may be associated with prior episodes of acute stress. <br><br>CONCLUSIONS: Pathologists are urged to explore these markers as supportive evidence in their own investigations of possible child abuse fatalities, especially when associated with stress.<p /> <p>Language: en</p>",
language="en",
issn="0002-9173",
doi="10.1093/ajcp/aqab204",
url="http://dx.doi.org/10.1093/ajcp/aqab204"
}