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

= 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. (Korean J Pediatr 2008;51:329-334