Kwashiorkor Uncovered by Chickenpox

Objective: To report a case of kwashiorkor among a 2- year old child that has been uncovered by chickenpox infection. Case Report: A 2-year old girl presented to the Emergency Department of Abha Maternity and Child Hospital, Abha City, Saudi Arabia, with progressive generalized pitting edema, mouth and lip ulceration, decreased activity and appetite, generalized hair loss with change in the color from black to fair and thin texture. The condition started about 2 months earlier after she developed chickenpox. On examination, there was miserable expression, apathy, angular stomatitis, fissured lips with oozing blood, puffy eyelids and face, generalized body swelling, bilateral pitting edema, hyper-pigmented lesions over the extensor surface of both forearm and legs, hypo-pigmented diaper area, sparse thin hair, and light in color. The liver was 3cm below the costal margin. The child was admitted to the Pediatrics Department, with kwashiorkor as highly suspected. Laboratory investigations revealed low serum total proteins and albumin levels, high aspartate ami- notransferase and alkaline phosphatase enzymes. The child was started on intravenous fluids, then on the next day she was started on nasogastric tube feeding. When the edema subsided, all mouth and lip lesions healed, and the mother was well-trained about handling nasogastric tube feeding and formula preparation, the child was discharged from the hospital facility to home-based care. Conclusions: Kwashiorkor among children is mainly due to improper weaning. Infections may precipitate and aggravate malnutrition among children. Health education of parents regarding proper nutrition and weaning for their infants is essential for its prevention. Physicians should be aware of its signs for early diagnosis and management.