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A 23-month-old girl with chronic ‘seborrhoeic’ dermatitis, dehydration and failure to thrive
  1. Pierluigi Marzuillo1,
  2. Anna Grandone1,
  3. Stefano Guarino1,
  4. Andrea Apicella2,
  5. Iacopo Panarese3,
  6. Ludovica Picciano1,
  7. Maria Cristina Fedele1,
  8. Federica Palladino1,
  9. Silverio Perrotta1,
  10. Emanuele Miraglia del Giudice1
  1. 1 Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Campania, Italy
  2. 2 Pediatric Department, AORN Santobono-Pausilipon, Napoli, Italy
  3. 3 Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Campania, Italy
  1. Correspondence to Dr Pierluigi Marzuillo, Department of Woman, Child and General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Napoli, Italy; pierluigi.marzuillo{at}gmail.com

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A 23-month-old girl with poor growth and decreased appetite over the past year (figure 1) and increased thirst (including night-time) for the last month was admitted with dehydration and somnolence without vomiting/diarrhoea. She appeared to be miserable and in pain. Capillary refill time was about 2 s. A 1 cm liver edge was palpable. Ear discharge was not evident. Her blood pressure was 75/40 mm Hg and pulse was 115 beats/min. A ‘seborrheic’ dermatitis of the scalp and of the suprapubic region—persisting for 1 year despite topical steroids and antibiotics—was evident (figure 2A–C). On biochemical examinations sodium was 143 mmol/L, glucose 4.1 mmol/L, urea 5.7 mmol/L, total serum proteins 43 g/L, albumin 22 g/L, alanine aminotransferase 227 IU/L, aspartate aminotransferase 181 IU/L, γ-glutamyl transferase 397 IU/L, C-reactive protein 89.3 nmol/L, erythrocyte sedimentation rate 80 mm/hour and creatinine 31.8 µmol/L. Urinalysis was normal, as well as international normalised ratio, prothrombin time and partial thromboplastin time. The abdominal ultrasound revealed a splenic hypoechoic area of about 1 cm. The child’s liquid intake and diuresis …

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Footnotes

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.