A kwashiorkor-like syndrome in a Caucasian with enteropathy

A Caucasian child with congenital heart disease (CHD) presented at the age of 19 months with a kwashiorkor-like syndrome. Jejunal biopsy showed sub-total villus atrophy. The clinical picture of repeated infection causing growth faltering followed by oedema, hair and skin changes, resembled the response to infection of many nutritionally stressed children in the tropical world. The exact aetiology of kwashiorkor and the diagnostic specificity of its clinical features remain in doubt, as does precise definition. This case highlights the problems of diagnosing a condition which is essentially the end point of a combination of nutritional and environmental stresses.