Sir.—We recently cared for a 16½-month-old Equadorian boy who presented with orange coloration and failure to thrive.
The child presented to the clinic for routine health care. Concern was raised about the child's growth. He weighed 8.3 kg (less than the fifth percentile), showing a 28-g gain in 11 weeks. His height was 76 cm (10th percentile) and his head circumference was 46.5 cm (10th percentile). The family indicated that this child had become difficult to feed and denied any specific food preferences.
The physical examination was remarkable for a very slight toddler whose skin was an intense orange color that was most obvious on his palms and soles. There was no scleral icterus. The remainder of the examination was unremarkable. Because of concern about this child's poor weight gain and unusual coloration, he was admitted to the hospital.
At the time of admission, the patient's hemoglobin level was