Kwashiorkor from a severe dietary restriction in an 8-month infant in suburban Detroit, Michigan: case report and review of the literature.

Kwashiorkor is a type of protein-calorie malnutrition often seen in children of impoverished countries and famine. The condition occurs in the setting of insufficient protein intake in the presence of sufficient caloric intake. We report a case of a 8-month-old male infant in the suburban Detroit, MI, USA who presented with diffuse edema, erythroderma and desquamation, a "bull-dog" face, diarrhea, and irritability, consistent with kwashiorkor as a result of severe dietary restriction. The mother had placed the child on a severely restrictive diet, consisting only of RICE DREAM((R)) milk, sweet potatoes and bananas, with the assumption that it would help his rash. Nineteen prior cases of kwashiorkor induced in infants by dietary restriction of "well intending" parents have been reported in the US literature. Malnutrition is often under diagnosed or misdiagnosed in developed countries such as the United States. The results, if unrecognized or untreated, may be devastating. This makes it imperative that physicians consider this diagnosis, recognize potential risk factors and be prepared to accurately assess overall nutritional status of patients.