A 3-month-old breastfed infant presents with tachycardia, cardiomegaly, and acute heart failure. The mother reports a diet consisting almost entirely of polished rice. There is no fever and sepsis workup is negative. The most likely diagnosis is:

• A Infantile beriberi (cardiac type) ✓
• B Congenital cyanotic heart disease
• C Endocardial fibroelastosis
• D Myocarditis due to coxsackievirus

Explanation

Infantile beriberi occurs in breastfed infants of thiamine deficient mothers, classically those subsisting on polished rice which strips away the thiamine rich pericarp. It presents as acute high output cardiac failure with tachycardia and cardiomegaly, and responds dramatically to parenteral thiamine. Myocarditis would show fever, raised inflammatory markers and a positive septic screen. Endocardial fibroelastosis is a chronic condition without the dietary history. The maternal polished rice diet is the discriminating clue.

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

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Written and medically reviewed by the StethoPrep medical team.