A case of kwashiorkor

Kwashiorkor is part of the spectrum of protein-energy malnutrition. The condition results from a lack of nutritional protein coupled with carbohydrate excess. Protein malnutrition is much more common in the Third World; however, it is also the most common form of nutritional deficiency among hospitalized patients in the United States. Cutaneous clues to the diagnosis of protein deficiency include the "flag sign," hypochromotrichia, alopecia, "crazy pavement" dermatosis, pallor, and glossitis. Systemic manifestations include peripheral edema, liver disease, neurologic changes, diarrhea, weight loss, and hypoalbuminemia. We report here a case of profound kwashiorkor in a nonhospitalized patient who presented with multiple cutaneous and systemic findings indicative of protein malnutrition.