Srpski arhiv za celokupno lekarstvo 2013 Volume 141, Issue 11-12, Pages: 810-813
https://doi.org/10.2298/SARH1312810S
Full text ( 642 KB)
Presentation of an infant with nutritional deficiency dermatitis as the initial manifestation of cystic fibrosis
Stojković Anđelka (Klinički centar „Kragujevac“, Pedijatrijska klinika, Kragujevac + Fakultet medicinskih nauka, Kragujevac)
Radlović Nedeljko (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Vuletić Biljana (Klinički centar „Kragujevac“, Pedijatrijska klinika, Kragujevac + Fakultet medicinskih nauka, Kragujevac)
Nestorović Branimir (Medicinski fakultet, Beograd + Univerzitetska dečja klinika, Beograd)
Leković Zoran (Univerzitetska dečja klinika, Beograd)
Obradović Slobodan (Klinički centar „Kragujevac“, Pedijatrijska klinika, Kragujevac + Fakultet medicinskih nauka, Kragujevac)
Vujić Ana (Klinički centar „Kragujevac“, Pedijatrijska klinika, Kragujevac + Fakultet medicinskih nauka, Kragujevac)
Introduction. Cystic fibrosis (CF) is a multisystemic autosomal recessive
disease most frequently recognized by characteristic respiratory and/or
digestive manifestations. Exceptionally rare, as is the case with the infant
we are presenting, the initial sign of the disease can be nutritional
deficiency dermatitis (NDD). Case Outline. A three-month-old male infant of
young and healthy non-consanguineous parents, born at term after the first
uneventful pregnancy, was hospitalized due to atopic dermatitis (AD)-like
skin changes, failure to thrive and normochromic anemia (Hb 60 g/L). As
exclusively breast-fed, failure to thrive was attributed to hypogalactia and
skin changes to nutritional allergy, so that, besides exclusion of cow’s milk
protein and other highly allergenic foods in mother’s diet, hypoallergenic
milk formula was added to the child’s diet. However, dietetic measures were
without effect, and the child was re-hospitalized at age 4.5 months, this
time in the condition of severe malnutrition with hypoproteinemic edemas,
extensive dermatitis, moderate hepatosplenomegaly and recurrent normochromic
anemia (Hb 57 g/L). After plasma-free erythrocyte transfusion, correction of
hypoalbuminemia and two-week parenteral and semi-elementary nutrition
resulted in gradual recovery of the child, also including the resolution of
skin changes. Having in mind the clinical course of the disease, as well as
the response to applied therapeutic measures, CF was suspected as the cause
of the child’s problems, which was also confirmed by a high level of sweat
chlorine (92 mmol/L) and DNA analysis (∆F508/∆F508). Conclusion. Our
experience indicates that NDD, as the initial manifestation of CF, should be
also kept in mind in differential diagnosis of the infant’s AD-like changes.
Keywords: cystic fibrosis, infant, nutritional deficit dermatitis