Kwashiorkor — DTM&H MCQ

Correct answer: E — Kwashiorkor

The correct answer is E, Kwashiorkor. This is oedematous severe acute malnutrition, and the WHO/UK-aligned definition of severe acute malnutrition (SAM) mandates that bilateral pitting oedema alone is sufficient to classify a child as having kwashiorkor, irrespective of the weight-for-height or MUAC values. The accompanying flaky paint dermatosis (patchy hyperpigmentation with desquamation, classically over friction sites) and sparse, discoloured, easily pluckable hair are classic cutaneous and hair signs of kwashiorkor, reflecting hypoalbuminaemia-driven oedema plus micronutrient and amino acid (methionine/cysteine) deficiency affecting keratin synthesis. The stem explicitly signals that oedema is the dominant clinical feature despite only modestly low weight-for-height, which is the defining discriminator separating kwashiorkor from purely wasting forms of malnutrition. Why the other options are wrong: C. Marasmus: This is severe wasting from generalised energy deficiency, presenting with a wizened, emaciated appearance and very low weight-for-height, but critically without nutritional oedema; the presence of oedema here excludes marasmus. B. Pellagra: This is niacin (vitamin B3) deficiency causing photosensitive dermatitis, diarrhoea and dementia (the 3 Ds), not bilateral pitting oedema with flaky paint dermatosis. D. Scurvy: This is vitamin C deficiency producing gum bleeding, perifollicular haemorrhages and poor wound healing, not oedematous malnutrition or flaky paint skin changes. A. Rickets: This is vitamin D/calcium/phosphate deficiency causing bony deformities (bowing, swollen wrists/knees, craniotabes), unrelated to oedema or dermatosis. Key point: Bilateral pitting oedema, regardless of anthropometric severity, is the defining criterion that classifies a malnourished child as kwashiorkor rather than marasmus.

Reference: DermNet NZ, Protein-energy malnutrition (Kwashiorkor), 2024, https://dermnetnz.org/topics/protein-energy-malnutrition