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?

Identifying the Complication Not Reported in an 8-Month-Old with Kwashiorkor

Based on the clinical presentation, atrophic rickets is the complication that is NOT reported in this infant with kwashiorkor.

Clinical Features Present in This Case

• Poor feeding: The 8-month-old infant is not eating well with scanty breast milk supplemented with rice 1
• Growth failure: Current weight of 6 kg, which is significantly below expected weight for age 1
• Hepatomegaly: Enlarged liver detected on examination 1, 2
• Bilateral pitting edema: Present in both lower limbs, a classic sign of kwashiorkor 3, 4
• Hair changes: Coarse, brittle, easily detached hair that is gradually becoming fairer in color 3

Analysis of Each Potential Complication

Liver Cirrhosis

• Liver involvement is clearly present in this case with hepatomegaly 1
• Hepatomegaly is a common finding in kwashiorkor due to fatty infiltration of the liver 2
• Long-term complications of untreated protein malnutrition can include progression to cirrhosis 1

Flaky Paint Dermatosis

• The description of coarse, brittle hair that is easily detached is consistent with the early stages of the characteristic dermatosis of kwashiorkor 3
• "Flaky paint" or "peeling paint" dermatosis is pathognomonic of kwashiorkor when present with edema in a malnourished child 3

Xerophthalmia

• Vitamin A deficiency commonly occurs alongside protein-energy malnutrition 5
• While not explicitly stated in the case, micronutrient deficiencies including vitamin A deficiency are expected in an infant with poor feeding and protein malnutrition 6

Hypoglycemia

• Hypoglycemia is a common complication in severe malnutrition 1
• The infant's diet of scanty breast milk supplemented with rice is inadequate in protein and likely also in calories, predisposing to hypoglycemia 1
• Hypoinsulinemia in malnutrition contributes to metabolic derangements including hypoglycemia 2

Atrophic Rickets

• There is no mention of bone deformities, frontal bossing, or other skeletal manifestations in this case 6
• While vitamin D deficiency can occur in malnourished children, the clinical presentation does not include any signs of rickets 6
• The other complications (hepatomegaly, edema, skin and hair changes, hypoglycemia) are all directly related to protein malnutrition, while rickets is primarily related to vitamin D and calcium metabolism 6

Pathophysiology of Kwashiorkor in This Case

• The infant's presentation is classic for kwashiorkor, a form of severe protein malnutrition 3, 7
• Hypoalbuminemia from protein deficiency leads to decreased oncotic pressure and peripheral edema 4
• Hepatomegaly results from fatty infiltration of the liver due to impaired protein synthesis and lipoprotein transport 2
• Hair changes occur due to protein deficiency affecting hair structure and pigmentation 3

Clinical Implications

• Immediate nutritional rehabilitation with gradual introduction of protein is essential 7
• Monitoring for refeeding syndrome and other metabolic complications is critical 8
• Treatment of associated infections and correction of electrolyte imbalances is necessary 4