HYDERABAD — A 5-month-old boy in Hyderabad was diagnosed with kwashiorkor after developing a rash following a switch from breastfeeding to diluted formula. The case was reported in the New England Journal of Medicine by Jashir Ahammed Kolathil, MBBS, and Gadhiraju Manisha Varma, DNB, DCH, of the All India Institute of Medical Sciences-Bibinagar.

The boy was brought to an outpatient clinic with a rash resembling "flaking paint" that had developed three weeks prior to the visit. The baby had been exclusively breastfed until 20 days before the clinic visit, when his mother switched to diluted formula due to difficulties producing enough milk.

Kolathil reported that a physical examination revealed the boy was "irritable, with sparse, wispy, hypopigmented hair, and pitting edema of the arms and legs." The outermost layer of skin on the boy's legs, arms, and torso was peeling with hyperpigmented patches, and the layer beneath was unusually hypopigmented.

The baby's weight-for-age z score was -3.4, and his length-for-age z score was -5.6. According to the World Health Organization, typical z-score ranges are between -2 and 2.

Kwashiorkor, also known as edematous malnutrition, is characterized by a severe protein deficiency. The condition can be diagnosed in malnourished patients based on edema alone. Left untreated in poverty-stricken settings, kwashiorkor has a fatality rate ranging from 30% to 50%.

The boy was admitted to the hospital and fed a therapeutic milk formula. Kwashiorkor is most prevalent in equatorial and sub-Saharan Africa. Hundreds of thousands of cases are believed to occur annually, but the condition is not routinely included in epidemiological surveys. Relapse rates for kwashiorkor can be high, and children recovering from the condition may be given ready-to-use therapeutic food. Cases of kwashiorkor have been linked to underlying disease, difficulty absorbing protein, and maltreatment and neglect.