A 3-month-old exclusively breastfed infant presents with vomiting, pallor, tachycardia, hepatomegaly, and a loud systolic murmur. The mother reports a diet consisting almost entirely of polished rice. Echocardiography shows a dilated heart with high-output failure. The most likely diagnosis is:

• A Infantile beriberi due to thiamine deficiency transmitted through breast milk ✓
• B Congenital acyanotic heart disease with feeding difficulty
• C Kwashiorkor with marasmic cardiac failure
• D Iron deficiency anaemia causing high-output cardiac failure

Explanation

Infantile beriberi occurs in breastfed infants whose thiamine-deficient mothers consume polished rice, presenting typically between 2 and 4 months with acute cardiac failure, tachycardia, cardiomegaly, hoarse cry and aphonia. The maternal dietary history is the discriminating clue, since the infant itself receives no complementary food. Iron deficiency anaemia also causes high-output failure, but it would not explain the polished rice history or the acute fulminant course typical of wet beriberi, which responds dramatically to parenteral thiamine.

Reference: Park's Textbook of Preventive and Social Medicine, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.