A three-year-old female child, dangerously underweight at 6.2 kg (normal weight for her age is 14 kg), presented at an MSF clinic in Yemen with multiple skin lesions and was in a coma and state of shock. A brief history of diarrhea, vomiting and inability to feed was reported. Her parents also noted that their three-year-old had missed developmental milestones and had never spoken or walked.  

The child was immediately admitted to the intensive care unit and began receiving antibiotics, intravenous fluids and nutrition support, to which the child responded; however, the child’s weakness, decreased mental alertness and limb swelling persisted.  

The case was submitted to the telemedicine platform and received by Dr. Alexia Knapp, a dermatologist based in the United States, who noted flaking skin on the trunk and upper and lower extremities, as well as edema, and confirmed the diagnosis of Marasmic Kwashiorkor. Marasmic Kwashiorkor is a severe form of malnutrition characterized by marked protein deficiency and calorie insufficiency.  

Dr. Knapp recommended nutritional support, such as micronutrient supplementation, to help treat the skin blemishes caused by mineral and vitamin deficiencies. Additionally, she advised keeping an eye out for any indications of a subsequent bacterial skin infection.  

As is typical for pediatric cases sent to telemedicine, a pediatrician was also assigned to this case. Dr. Maria-Claudia Senatore Soares, a pediatrician based in Brazil, suggested the urgent management of possible electrolyte imbalance that is often seen in children with malnutrition. She gave extensive recommendations for the treatment of the child’s electrolyte imbalance, which guided the project medical team’s care strategy. Due to anemia, the child also received a blood transfusion.  

After receiving all these treatments, the child’s condition significantly improved. She regained full consciousness, had reduced leg edema, and was sent home to her family after 10 days.  

Severe malnutrition is a major problem in Yemen and exacerbated by the war. Around half of all children in Yemen are chronically malnourished. The good news is that if treatment is started early, malnourished children usually recover well, as demonstrated by this three-year-old who was expertly treated by the local medical team and our telemedicine specialists. 

By Dr Nilza Angmo and Dr Ahmed Igbin