Slideshow: Cases Involving Malnourishment

Click through these case report slides to brush up on cases involving malnourishment, including vitamin D deficiency and rickets. Each slide has a link to the full case report for more information.

Severe vitamin B12 deficiency can lead to pseudothrombotic microangiopathy, which can present similarly to the microangiopathic hemolytic anemias, particularly thrombotic thrombocytopenic purpura and disseminated intravascular coagulation. Recognition of the clinical and laboratory features of pseudothrombotic microangiopathy is important, since management with vitamin B12 replacement is simple and effective.

Read the full case report here.

Although non-accidental injury was strongly considered in this case of multiple fractures in a non-ambulating child, vitamin D deficiency rickets was the diagnosis based on the history, laboratory, and radiological abnormalities. His primary risk factor was exclusive breast-feeding without supplementation.

Read the full case report here.

During a well-child visit, the mother of a 13-month-old boy expresses concern about her son’s bowed legs. He had been exclusively breastfed until age 6 months. He is still breastfed at 13 months. The child lives in Michigan with his family. His medical history is unremarkable.

The radiograph shows cupping, fraying, and widening of the metaphysis. Further evaluation reveals normal blood calcium and phosphorus levels; however, the level of alkaline phosphatase is markedly elevated and the 25-hydroxyvitamin D level is very low at 5 ng/mL. This child had not received vitamin D supplementation, was dark-skinned, and lived in Michigan where he spent most of his first 12 months of life indoors with a lack of sun exposure—factors that point to a diagnosis of vitamin D deficiency rickets.

Read the full case report here.

The mother of a 4-year-old boy is concerned about his habit of eating stones and wall plaster; the habit has persisted for the past year. The child has a tendency toward constipation. He recently had abdominal pain and some discomfort with defecation. Small pebbles have been noted in the child’s stool. His family is of low socioeconomic status; his mother, a single parent, receives social assistance.

The radiograph shows multiple round densities, suggestive of pebbles. Air is present throughout the bowel; there is no sign of obstruction. Laboratory studies reveal a hemoglobin level of 11.3 g/dL, an iron level of 28 µg/dL, and a ferritin level of 5 ng/mL. Mean corpuscular volume was 74 fL, mean corpuscular hemoglobin concentration, 32.2 g/dL; red blood cell count, 47,200/µL; and platelet count, 484,000/µL.

Read the full case report here.

A 4-year-old, unimmunized African American girl presented with crampy abdominal pain, intermittent bloody diarrhea, occasional nighttime fever, decreased appetite, and a 4.5-kg weight loss over a 4-month period. She had no recent travel history, and no sick contacts were reported.

Once her nutritional and hemodynamic status had been stabilized, the patient was able to undergo an endoscopy/colonoscopy on hospital day 26, which revealed profuse patchy ulcers with large pseudopolyps.

Read the full case report here.

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