What complication is not reported in an 8-month-old infant with a history of poor feeding, hepatomegaly, bilateral pitting edema, and coarse brittle hair, weighing 6 kg?

Atrophic Rickets is Not Reported in This Infant with Kwashiorkor

Based on the clinical presentation, the complication that is NOT reported in this 8-month-old infant is atrophic rickets.

Clinical Features of the Infant Consistent with Kwashiorkor

• The infant presents with poor feeding, hepatomegaly, bilateral pitting edema of lower limbs, coarse and brittle hair that is easily detached and becoming fairer in color - all classic signs of kwashiorkor, a form of severe protein malnutrition 1
• The infant's weight of 6 kg at 8 months is significantly below expected weight for age, indicating failure to thrive 2
• History reveals inadequate nutrition with the mother compensating scanty breast milk with rice and potatoes, providing carbohydrates but insufficient protein 3

Analysis of Each Potential Complication

Liver Cirrhosis

• Hepatomegaly is explicitly mentioned in the case presentation 2
• Prolonged protein malnutrition can lead to fatty infiltration of the liver and eventual progression to fibrosis 4
• The soft, enlarged liver is a classic finding in kwashiorkor 3

Flaky Paint Dermatosis

• The description of "coarse, brittle, easily detached" hair with gradual lightening of color is consistent with the dermatological manifestations of kwashiorkor 1
• "Flaky paint" dermatosis is pathognomonic of kwashiorkor, characterized by darkly pigmented patches that peel or desquamate 1

Xerophthalmia

• Vitamin A deficiency commonly accompanies protein-energy malnutrition 2
• Xerophthalmia (dry eyes) is a known ocular manifestation in severe malnutrition 2

Hypoglycemia

• Hypoglycemia is a common metabolic complication in kwashiorkor 5
• The combination of inadequate caloric intake and impaired gluconeogenesis due to protein deficiency leads to hypoglycemia 4
• Hypoinsulinemia plays an important role in the development of edema and hepatomegaly during malnutrition 4

Atrophic Rickets

• There is no mention of bone deformities, frontal bossing, or other skeletal manifestations in this infant 6
• While vitamin D deficiency can accompany malnutrition, the classic presentation of kwashiorkor does not typically include rickets as a primary feature 2
• The clinical picture focuses on edema, hepatomegaly, and dermatological changes rather than skeletal abnormalities 1

Pathophysiology of Kwashiorkor

• Kwashiorkor results from severe protein deficiency with relatively adequate carbohydrate intake 3
• Hypoalbuminemia is a key feature that leads to decreased oncotic pressure and subsequent edema 5
• The pitting edema in both lower limbs is directly related to hypoalbuminemia 5
• Hepatomegaly results from fatty infiltration of the liver due to impaired protein synthesis and lipoprotein transport 4

Clinical Pearls

• Kwashiorkor differs from marasmus (another form of severe malnutrition) by the presence of edema 1
• The characteristic hair changes (coarse, brittle, easily detached, and lightening in color) are important diagnostic features 1
• Early recognition and appropriate nutritional rehabilitation are essential to prevent mortality 5
• The combination of hepatomegaly and bilateral pitting edema in an infant with poor weight gain should raise suspicion for kwashiorkor 3