Pathological Case of the Month FREE

A 7-MONTH-OLD BOY with malnutrition and chronic diarrhea came to the emergency department with dehydration and metabolic acidosis. His medical history revealed that he had diarrhea, vomiting, and abdominal distension for 1½ months. His stool was defined as foul-smelling, greasy, and bulky. He was born from nonconsanguineous parents following an uneventful pregnancy. He had been breastfed until he was 3 months old, at which time he began receiving formula, rice, and biscuits.

At physical examination, his weight was 5800 g (<3rd percentile), his height was 68 cm (<75th percentile), and his head circumference was 42 cm(<10th percentile). He was dehydrated and his abdomen was severely distended but there was no organomegaly. Results of laboratory investigations were compatible with metabolic acidosis and mild hypokalemia. A complete blood cell count showed hemoglobin to be 11.4 g/dL; hematocrit, 35.3%; mean corpuscular volume, 71.9 fL; white blood cell count, 9.2 × 10³/µL (9.2 × 10⁹/L); and platelets, 220 × 10³/µL (220 × 10⁹/L). A peripheral blood smear revealed 36% granulocytes, 52% lymphocytes, 10% monocytes, 2% bands, and generalized acanthocytosis was noticed, involving more than 80% of erythrocytes (Figure 1).

Accepted for publication April 18, 2000.

Corresponding author: Ahmet Karadag, MD, Department of Pediatrics, Fatih University Medical School, Ciftlik Caddesi No. 57 06510, Emek Ankara, Turkey (e-mail: kara_dag@hotmail.com).