All issues > Volume 51(3); 2008

Case Report

Korean J Pediatr. 2008;51(3):329-334. Published online March 15, 2008.

A case of lethal kwashiorkor caused by feeding only with cereal grain

Hyun Ju HJ Lee¹, Kyung Hye KH Km¹, Hye Jin HJ Park¹, Kye Hyang KH Lee¹, Gyeong Hoon GH Lee¹, Eun Jin EJ Choi¹, Jin Kyung JK Kim¹, Hai Lee HL Chung¹, Woo Taek WT Kim¹

¹Department of Pediatrics, College of Medicine, Daegu Catholic University, Daegu, Korea

Correspondence Woo Taek WT Kim ,Email: wootykim@cu.ac.kr

Abstract

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.

Keywords :Kwashiorkor, Infection, Immune deficiency, Dilated cardiomyopathy