Custer Adam, Custer Dylan, Shao Paul, Kirolos Henry
Department of Internal Medicine and Pediatrics, University of California Los Angeles (UCLA), Los Angeles, CA, USA.
Undergraduate Studies, Clarkson University, Potsdam, NY, USA.
Am J Case Rep. 2021 Feb 4;22:e928468. doi: 10.12659/AJCR.928468.
BACKGROUND Kwashiorkor disease is a subtype of severe acute protein malnutrition characterized by peripheral edema associated with hypoalbuminemia and ascites. It can result from both protein deficiency and protein loss. In resource-poor countries, the disease often is caused by inadequate dietary intake, but in resource-rich countries, it can be seen as a rare complication of severe malabsorption. CASE REPORT We present the case of a 60-year-old woman who presented with 1 week of progressive anasarca in the setting of decreased dietary intake and poor tolerance of total parenteral nutrition (TPN). She had a history of Roux-en-Y gastric bypass surgery which was complicated by a strangulated internal hernia that required an exploratory laparotomy and small bowel resection. She subsequently developed short gut syndrome with TPN dependence. Work-up revealed hypoalbuminemia with several micronutrient deficiencies consistent with secondary kwashiorkor disease. With a multidisciplinary approach that included Gastroenterology, Pharmacy, and Nutrition, she was treated with albumin, furosemide, nutritional supplementation, and ultimately rechallenged with TPN. At discharge, her swelling had improved, her weight had decreased, and her albumin improved to the normal range. CONCLUSIONS This case is a unique presentation of secondary kwashiorkor disease. In our patient, the combination of gastric bypass surgery and short gut syndrome with poor TPN tolerance likely led to severe protein malabsorption. This underscores the importance of recognizing the signs and symptoms of kwashiorkor disease and understanding the associated complications so that treatment can be instituted promptly. Furthermore, the case demonstrates how an interdisciplinary approach to management can increase the chance of a successful outcome.
夸休可尔症是严重急性蛋白质营养不良的一种亚型，其特征为伴有低蛋白血症和腹水的外周性水肿。它可由蛋白质缺乏和蛋白质丢失引起。在资源匮乏的国家，该疾病通常由饮食摄入不足导致，但在资源丰富的国家，它可被视为严重吸收不良的一种罕见并发症。病例报告：我们报告一例60岁女性病例，该患者在饮食摄入量减少及对全胃肠外营养（TPN）耐受性差的情况下，出现了1周的进行性全身性水肿。她有 Roux-en-Y 胃旁路手术史，术后并发绞窄性内疝，需要进行剖腹探查和小肠切除术。随后她发展为短肠综合征并依赖TPN。检查发现低蛋白血症以及几种与继发性夸休可尔症相符的微量营养素缺乏。通过包括胃肠病学、药学和营养学在内的多学科方法，她接受了白蛋白、呋塞米、营养补充治疗，最终再次接受TPN治疗。出院时，她的肿胀有所改善，体重减轻，白蛋白水平恢复到正常范围。结论：该病例是继发性夸休可尔症的独特表现。在我们的患者中，胃旁路手术和短肠综合征合并TPN耐受性差可能导致了严重的蛋白质吸收不良。这强调了认识夸休可尔症的体征和症状以及了解相关并发症以便及时进行治疗的重要性。此外，该病例展示了跨学科管理方法如何能增加成功治疗的机会。
