Sir.—Pickwickian syndrome is a rare clinical condition characterized by exogenous obesity, severe cardiorespiratory distress with cyanosis, somnolence, and a voracious appetite.
Recently a 7-year-old girl with pickwickian syndrome was seen at Hacettepe Children's Hospital, Ankara, Turkey. She had been followed up since August 1982 because of acute lymphoblastic leukemia. The patient had been in remission since September 1982 and was on maintenance therapy with mercaptopurine and methotrexate, which was planned to be discontinued in September 1985. A month prior to the patient's last admission on Sept 2, 1985, her mother noticed that her appetite was getting voracious but without vomiting and headache. The patient was eating when she was not sleeping, and she gained more than 7 kg. Lately, snoring and some cyanosis of the lips were also noticed.
Physical examination revealed a somnolent, obese girl (33.5 kg) with tachypnea (36 respirations per minute), tachycardia (148 beats per minute),