Kwashiorkor — DTM&H MCQ

Correct answer: C — Kwashiorkor

Kwashiorkor (option C) is correct. The vignette describes the classic triad of bilateral pitting oedema, flaky-paint dermatosis and sparse, depigmented hair with apathy in a child whose weight-for-height is relatively preserved compared with the striking oedema; this is oedematous (protein-energy) malnutrition. WHO defines nutritional oedema as diagnostic of severe acute malnutrition regardless of the anthropometric wasting score, and the skin and hair changes reflect impaired protein synthesis and hepatic dysfunction rather than pure calorie deficiency. Apathy and irritability are typical behavioural features of kwashiorkor, distinguishing it from the alert, hungry appearance of marasmic children. Why the other options are wrong: E. Scurvy: caused by vitamin C deficiency, presenting with gum bleeding, perifollicular haemorrhages and poor wound healing, not oedema or flaky-paint dermatosis. B. Beriberi: due to thiamine deficiency, causing high-output cardiac failure (wet beriberi) or peripheral neuropathy (dry beriberi); oedema here is cardiac, not the classic nutritional oedema with dermatosis described. A. Pellagra: results from niacin deficiency, classically causing the triad of dermatitis (photosensitive, symmetrical), diarrhoea and dementia, not the sparse hair and pitting oedema pattern seen here. D. Marasmus: represents severe wasting from overall calorie and protein deficiency with a very low weight-for-height, but characteristically lacks oedema; the child appears wizened and wasted, not swollen. Key point: Bilateral pitting oedema with skin and hair changes despite only modestly reduced weight-for-height defines kwashiorkor, whereas marasmus is oedema-free severe wasting.

Reference: WHO. Guideline: Updates on the Management of Severe Acute Malnutrition in Infants and Children. Geneva: World Health Organization; 2013 (nutritional oedema as diagnostic criterion for kwashiorkor/severe acute malnutrition). https://www.ncbi.nlm.nih.gov/books/NBK190316/