A 14-month-old boy is brought with progressive weight loss over four months. He is irritable but alert, has marked wasting of the buttocks and limbs with loose skin folds, subcutaneous fat is nearly absent, and there is no oedema. Hair and skin appear normal. Weight-for-length is below the third percentile. What is the MOST likely diagnosis?

• A Marasmus ✓
• B Kwashiorkor
• C Marasmic kwashiorkor
• D Primary lactose intolerance

Explanation

Marasmus results from severe deficiency of total energy including protein, producing extreme wasting, loss of subcutaneous fat, and absence of oedema, with the child typically alert. Kwashiorkor shows oedema, hepatomegaly, and hair changes with relatively preserved weight, so option B is excluded by the absent oedema. Marasmic kwashiorkor requires oedema superimposed on wasting, which is not present here. Lactose intolerance causes chronic diarrhoea rather than this pure wasting phenotype.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.