What Came First: Malnutrition or Severe Disease?
Megan N Carey1,2, Lindsay H Cameron1,2,3, Nicholas L Rider4,5
1Department of Pediatrics.
Pediatrics
|August 1, 2023
Summary
A young woman with depression experienced severe weight loss and a complex illness involving lung opacities, pericardial effusion, and skin issues. Early treatment showed improvement, but a relapse complicated her recovery, requiring multidisciplinary care.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Cardiology
Background:
- A 20-year-old female with depression presented with chronic weight loss, weakness, fatigue, hair loss, rash, palpitations, and cough.
- She had a 50-pound unintentional weight loss over 2 years despite nutritional supplementation and a normal gastrointestinal workup.
Observation:
- Physical examination revealed marked cachexia (BMI 10.3 kg/m2), hypotension (84/69 mmHg), diminished breath sounds, skin breakdown, rash, and nonpitting edema.
- Imaging showed a right upper lobe opacity with cavitation, lucent lesions in the humerus, and a large pericardial effusion.
Findings:
- Initial treatment with antitubercular and antibiotic therapy along with nutritional rehabilitation led to improvement.
- The patient experienced an acute worsening with persistent fevers, worsening cough, new murmur, and increased consolidation on CT scan.
Implications:
- This case highlights the diagnostic challenges in patients with severe malnutrition and complex infectious or inflammatory processes.
- Multidisciplinary consultation is crucial for managing such complicated clinical courses, emphasizing the interplay between nutritional status, infection, and cardiac complications.
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