Surak Aimann, Bravo Grace, McMurray Amanda, Altamirano-Diaz Luis, Taheri Sepideh
Department of Paediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada.
Cardiol Young. 2019 Oct;29(10):1278-1281. doi: 10.1017/S1047951119002129. Epub 2019 Sep 2.
We report a case of a 13-year-old male with trisomy 21 in Southwestern Ontario, Canada, who presented with bilateral pneumonia, pericardial effusion, and peripheral oedema. The pericardial effusion did not respond to standard treatment options. Evaluation revealed severe dietary restriction, consistent with kwashiorkor. Hospital course was complicated by severe hypoalbuminaemia, hypocalcaemia, hypomagnesaemia, and hypophosphataemia. The pericardial effusion and other findings resolved gradually upon slow introduction of a well-balanced diet and adequate caloric and protein intake. Kwashiorkor is an unusual cause of pericardial effusion and can be overlooked especially in developed countries. It is a type of protein-calorie malnutrition often seen in children of impoverished countries and famine. It is a result of insufficient protein intake in the context of adequate caloric intake. Pericardial effusion not responding to usual treatment is a challenge, and other aetiologies must be considered. Malnutrition is often underdiagnosed or misdiagnosed in developed countries with devastating outcomes if unrecognised. This makes it imperative to consider this diagnosis, recognise potential risk factors, and be prepared to accurately assess overall nutritional status.
我们报告了一例来自加拿大安大略省西南部的13岁男性唐氏综合征患者，该患者出现双侧肺炎、心包积液和外周水肿。心包积液对标准治疗方案无反应。评估显示存在严重的饮食限制，符合夸希奥科病。住院期间出现严重低白蛋白血症、低钙血症、低镁血症和低磷血症等并发症。在缓慢引入均衡饮食并给予足够热量和蛋白质摄入后，心包积液及其他症状逐渐缓解。夸希奥科病是心包积液的一种罕见病因，尤其在发达国家可能被忽视。它是一种蛋白质 - 热量营养不良，常见于贫困国家的儿童及饥荒时期。它是在热量摄入充足的情况下蛋白质摄入不足的结果。心包积液对常规治疗无反应是一个挑战，必须考虑其他病因。在发达国家，营养不良常常未被诊断或误诊，如果未被识别会导致严重后果。这使得必须考虑这一诊断，识别潜在风险因素，并准备好准确评估整体营养状况。
