A child with kwashiorkor misdiagnosed as atopic dermatitis

Although uncommon, kwashiorkor continues to occur in developed, but mainly in developing nations. It is a type of protein-calorie malnutrition that occurs in the setting of insufficient protein intake in the presence of sufficient caloric intake. Skin and hair changes should prompt a thorough dietary history and appropriate dietary intervention. We report a case of a 12-month old girl in Belo Horizonte, Minas Gerais, Brazil, who presented with diffuse edema, desquamation, and irritability misdiagnosed as atopic dermatitis. The diagnosis was consistent with kwashiorkor as a result of severe dietary restriction. The mother had placed the child on a severely restrictive diet, consisting only of potatoes, gelatin, and juice as a consequence of the inability to breastfeed. Kwashiorkor is often underdiagnosed or misdiagnosed and if unrecognized or untreated, may be devastating. This makes it imperative that physicians consider this diagnosis, recognize potential risk factors, and be prepared to accurately assess overall nutritional status of patients.