Korean Journal of Pediatrics 2008;51(3):329-334.
Published online March 15, 2008.
A case of lethal kwashiorkor caused by feeding only with cereal grain
Hyun Ju Lee, Kyung Hye Km, Hye Jin Park, Kye Hyang Lee, Gyeong Hoon Lee, Eun Jin Choi, Jin Kyung Kim, Hai Lee Chung, Woo Taek Kim
Department of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea
미음 수유만으로 발생한 치명적인 Kwashiorkor 1례
이현주, 금경혜, 박혜진, 이계향, 이경훈, 최은진, 김진경, 정혜리, 김우택
대구가톨릭대학교 의과대학 소아과학교실
Woo Taek Kim, Email: wootykim@cu.ac.kr
Kwashiorkor is a syndrome of severe protein malnutrition, which manifests itself in hypoalbuminemia, diarrhea, dermatitis, and edema. It can be life-threatening due to associated immune deficiency and an increased susceptibility to infections. Kwashiorkor should be treated early with nutritional support and the control of infection. Dilated cardiomyopathy may develop during the treatment and in such cases a poor prognosis is expected. Kwashiorkor has been known as a common disease of poor countries. To date, in fact, there has been no report of kwashiorkor leading to death in technically advanced countries. We here report a fatal case of a baby girl admitted with kwashiorkor. She had been fed only with cereal grain mixed with juice, without any protein supplement, for 2 months. This diet was deficient not because of poverty, but due to the illiteracy of her parents. The patient suffered from diarrhea, whole body edema, hypothermia, and dermatitis. Laboratory findings revealed an immune-deficient state featuring leukopenia and decreased immunoglobulin. Blood and urine cultures revealed Alcaligenes Xylosoxidans growth. The patient was fed frequent small amounts of protein-containing formula and intravenous albumin and micronutrients were administered for nutritional support. She was also treated with intravenous immunoglobulin and antibiotics in order to control infection. Nevertheless, she developed dilated cardiomyopathy and multi-organ failure and died. We review this case in light of the literature.
Key Words: Kwashiorkor, Infection, Immune deficiency, Dilated cardiomyopathy

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