title: [Adult kwashiorkor: a rare complication of bariatric surgery].
abstract: BACKGROUND
  Kwashiorkor is a clinical manifestation of global protein-calorie malnutrition that is described mainly in children in developing countries initially presenting eczema-like skin disease associated with hydrops.
  
  
  METHODS
  We report the case of a 44-year-old woman with dark skin who had undergone bariatric surgery for treatment of stage-III obesity without regular monitoring and who was hospitalized in our dermatology department four years later. She had diffuse oedema and asteatotic eczema-like cutaneous lesions on pigmented skin that had developed for two months despite daily application of topical corticosteroids. Clinical signs, the collapse of serum albumin and histopathological analysis of skin tissue were evocative of kwashiorkor. Her symptoms subsided after several weeks of a nutritional programme.
  
  
  CONCLUSIONS
  Kwashiorkor is a clinical entity described chiefly in children in developing countries. Cutaneous involvement comprising asteatotic eczema-like skin associated with diffuse oedema is prominent. Treatment with protein supplementation alone is effective and avoids many complications such as infections and haemodynamic disorders. Obesity is a serious and common disease in Western countries affecting one third of the world's population, and for which treatment with bariatric surgery may be indicated. Without regular monitoring, this surgery can cause severe protein deficiency. Consequently, in the future there will seemingly be a greater likelihood of kwashiorkor in adults as an iatrogenic complication of obesity treatment. Its semiology needs to be underlined because of the simplicity and efficacy of treatment.
authors.affiliation: Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France. Electronic address: boutin.damien@gmail.com.
authors.forename: D
authors.initials: D
authors.lastname: Boutin
authors.affiliation: Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
authors.forename: V
authors.initials: V
authors.lastname: Cante
authors.affiliation: Service d'anatomie et cytologie pathologiques, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Levillain
authors.affiliation: Service d'endocrinologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
authors.forename: X
authors.initials: X
authors.lastname: Piguel
authors.affiliation: Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie 86021 Poitiers cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Guillet
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000009:adverse effects*; D006801:Humans; D007732:Kwashiorkor / Q000209:etiology*
keywords: Bariatric surgery; Chirurgie bariatrique; Kwashiorkor; Malnutrition; Obesity; Obésité