Boutin D, Cante V, Levillain P, Piguel X, Guillet G
Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
Ann Dermatol Venereol. 2015 Feb;142(2):99-103. doi: 10.1016/j.annder.2014.11.006. Epub 2014 Dec 30.
Kwashiorkor is a clinical manifestation of global protein-calorie malnutrition that is described mainly in children in developing countries initially presenting eczema-like skin disease associated with hydrops.
We report the case of a 44-year-old woman with dark skin who had undergone bariatric surgery for treatment of stage-III obesity without regular monitoring and who was hospitalized in our dermatology department four years later. She had diffuse oedema and asteatotic eczema-like cutaneous lesions on pigmented skin that had developed for two months despite daily application of topical corticosteroids. Clinical signs, the collapse of serum albumin and histopathological analysis of skin tissue were evocative of kwashiorkor. Her symptoms subsided after several weeks of a nutritional programme.
Kwashiorkor is a clinical entity described chiefly in children in developing countries. Cutaneous involvement comprising asteatotic eczema-like skin associated with diffuse oedema is prominent. Treatment with protein supplementation alone is effective and avoids many complications such as infections and haemodynamic disorders. Obesity is a serious and common disease in Western countries affecting one third of the world's population, and for which treatment with bariatric surgery may be indicated. Without regular monitoring, this surgery can cause severe protein deficiency. Consequently, in the future there will seemingly be a greater likelihood of kwashiorkor in adults as an iatrogenic complication of obesity treatment. Its semiology needs to be underlined because of the simplicity and efficacy of treatment.
夸希奥科病是一种全身性蛋白质 - 热量营养不良的临床表现，主要见于发展中国家的儿童，最初表现为与水肿相关的湿疹样皮肤病。
我们报告一例44岁黑人女性病例，该患者因III期肥胖症接受了减肥手术，但未进行定期监测，四年后在我们皮肤科住院。她有色沉着皮肤上出现弥漫性水肿和干性湿疹样皮肤损害，尽管每天外用糖皮质激素，这种情况仍持续了两个月。临床症状、血清白蛋白降低以及皮肤组织的组织病理学分析提示夸希奥科病。经过数周的营养方案治疗后，她的症状有所缓解。
夸希奥科病主要是在发展中国家儿童中描述的一种临床病症。突出表现为包括与弥漫性水肿相关的干性湿疹样皮肤的皮肤受累。仅补充蛋白质治疗有效，可避免许多并发症，如感染和血液动力学紊乱。肥胖症在西方国家是一种严重且常见的疾病，影响着全球三分之一的人口，减肥手术可能是其治疗方法之一。如果没有定期监测，这种手术可能导致严重的蛋白质缺乏。因此，未来夸希奥科病作为肥胖症治疗的医源性并发症在成年人中出现的可能性似乎会更大。由于其治疗方法简单有效，其症状学需要引起重视。
