Severe nutritional/kwashiorkor-associated dermatosis in a 3-year-old child from rural Ethiopia: a case report

Severe nutritional dermatosis with extensive desquamation is an uncommon manifestation of severe acute malnutrition (SAM). We report a 3-year-old child with SAM who developed generalized hyperpigmented, thickened, fissured, and peeling skin involving the entire body, followed by multiorgan dysfunction and death despite intensive management. A 3-year-old Ethiopian male child, the third-born in his family, from a rural area presented to our hospital with a 1-month history of progressive skin peeling and discoloration, vomiting, diarrhoea, and bilateral lower-extremity oedema. He was diagnosed with complicated SAM with grade III kwashiorkor-associated dermatosis, hypothermia, hypoglycemia, and shock. Routine laboratory investigations were performed, and he was managed according to national and World Health Organization (WHO) guidelines for the management of severe acute malnutrition. Despite intensive treatment and supportive care, his condition rapidly deteriorated, and he died on the fifth day of hospitalization from multiorgan failure attributed to septic shock. This case highlights the severe dermatological complications that can occur in children with SAM. Kwashiorkor dermatosis may mimic other serious skin disorders and is associated with high mortality, particularly in resource-limited settings. Early recognition, prompt nutritional rehabilitation, and appropriate management of infections and metabolic complications are crucial to improve outcomes.