A five-month-old full-term baby was brought to the outpatient clinic in India with a three-week history of a rash. He had consumed breast milk exclusively until 20 days before presentation, when he had been switched to diluted formula due to his mother’s ongoing challenges with limited breast-milk supply. His weight-for-age score was below normal, as was his length-for-age score. On physical examination, the baby was irritable, with sparse, wispy, hypopigmented hair and pitting edema (when the skin is pressed on, it leaves a depression [or pit]). Desquamation (peeling) of hyperpigmented patches were seen on the legs, arms, and trunk; the underlying skin was hypopigmented. A serum albumin (protein) level was 1.9 g per deciliter (reference range 3.5 to 5.0).
A diagnosis of kwashiorkor – also known as edematous malnutrition or severe acute malnutrition with pitting edema of the arms and legs – was made. Kwashiorkor may be diagnosed in malnourished children on the basis of the presence of pitting edema, regardless of height and weight values (it is extremely rare in the US). The typical dermatosis (skin condition), resembles flaking paint.
The baby was admitted to the hospital and treatment with therapeutic milk formula was initiated. On day seven, the baby was more active, with resolving skin lesions. At follow-up visit two weeks after discharge, the rash had disappeared and weight gain had normalized.
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