Nutritional Deficiency Dermatosis with Streptococcal Sepsis in an Aboriginal Child: a Case Report
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MEDICINE
Nutritional Deficiency Dermatosis with Streptococcal Sepsis in an Aboriginal Child: a Case Report Lii Jye Tan 1 & Mohammad Shafie Othman 1 & Jyh Jong Tang 2 & Kum Thong Wong 3 & Shau Kong Lai 4 & Geok Chin Tan 5 & Mohammad Hadri Shamshuddin 1 Accepted: 13 October 2020 # Springer Nature Switzerland AG 2020
Abstract A 7-month-old baby boy succumbed to death with a history of static weight gain since 4 months of age. Autopsy revealed florid skin lesions, evidence of malnutrition, pneumonia, and meningitis. Further testing isolated Streptococcus pyogenes in the blood culture. The skin lesions are highly likely due to the dermatosis in kwashiorkor and acquired zinc deficiency, complicated with bacterial infection and overgrowth of saprophytic fungal yeast cells. Keywords Zinc deficiency . Flaky paint dermatosis . Kwashiorkor . Meningitis . Pneumonia
Introduction Zinc is an essential trace mineral that is present naturally in some foods. It is an important intracellular mediator which stabilizes the cell membranes, reduces free radical, limits lipid peroxidation, and prevents ultraviolet radiation damage [1, 2]. Zinc deficiency is characterized by peculiar skin lesions, diarrhea, neurological disturbance, or recurrent infection. In this case, an aboriginal child was underdiagnosed with severe malnutrition despite the florid skin lesions. He succumbed to death
This article is part of the Topical Collection on Medicine * Lii Jye Tan [email protected] 1
Department of Forensic Medicine, Hospital Raja Permaisuri Bainun, Jalan Raja Ashman Shah, 30450 Ipoh, Perak Darul Ridzuan, Malaysia
2
Department of Dermatology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia
3
Department of Pathology, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
4
Histopathology Unit, Department of Pathology, Hospital Raja Permaisuri Bainun, Ipoh, Perak Darul Ridzuan, Malaysia
5
Department of Pathology, Faculty Medicine, National University of Malaysia, Bangi, Selangor, Malaysia
after 4 months of poor weight gain with streptococcalrelated meningitis and pneumonia.
Case Report Herein, we report the case of a 7-month-old indigenous baby boy who was first noticed with static weight gain at 5.6 kg at 4 to 6 months of age and weight loss to 5.1 kg at 7 months of age. Three weeks before his death, the mother noticed the onset of maculopapular rashes over the perineum and inguinal region, which subsequently spread to the lower limbs and buttocks. The rashes disappeared spontaneously, followed by an erythematous patch distributed around the limbs, torso with foci of blister over the lower back, abdomen, and right thigh. A confluence of erythematous lesions formed a larger plaque of lesions. He also suffered from poor oral intake and intermittent diarrhea. The autopsy reported extensive crusted lesions over the face, neck, bilateral upper limbs, axilla, and left lower limb (Figs. 1 and 2). A well-circumscribed erythematous patch over the buttock extended to the middle third of both thighs and the scrot
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