A Sharply Marginated Erythematous Dermatitis in a Toddler

    July 2022 in “ Pediatric dermatology ”
    Paola Borgia, Gianmaria Viglizzo
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    TLDR A toddler with a rash and developmental delays improved after treatment for severe malnutrition caused by a diet lacking in protein.
    A 33-month-old boy presented with a 2-month history of a diffuse rash, hair depigmentation, and loss of motor and verbal skills, which was diagnosed as kwashiorkor, a form of malnutrition caused by insufficient protein intake. The child had been exclusively consuming rice milk, which has significantly less protein than cow's milk. Laboratory analysis showed severe hypoalbuminemia, iron-deficiency anemia, and hypogammaglobulinemia. The diagnosis was confirmed by the response to a therapeutic diet, which included peptide-based enteral feeds, oral milk-based formula, and a full diet, along with intramuscular vitamin K and a daily multivitamin supplement. The child showed marked clinical improvement within a few weeks. The case emphasizes the importance of a detailed dietary history and examination of skin and appendages in patients with dermatoses suspicious for nutritional deficiency.
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