A 3-month-old exclusively breastfed infant presents with tachycardia, cardiomegaly, and a weak hoarse cry (aphonia). The mother reports a diet consisting almost entirely of polished rice. What is the most likely diagnosis?

• A Infantile beriberi ✓
• B Congenital hypothyroidism
• C Neonatal tetany
• D Galactosaemia

Explanation

The combination of acute cardiac failure features (tachycardia, cardiomegaly) with aphonia in a breastfed infant whose mother eats polished rice is classic infantile beriberi due to thiamine deficiency transmitted through breast milk. Polished rice loses most of its thiamine content with milling. Congenital hypothyroidism causes lethargy and coarse features rather than acute cardiac decompensation, and galactosaemia presents with jaundice, vomiting and hepatomegaly after milk feeds.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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