Abstract

Severe Kwashiorkor and Scurvy Secondary to Avoidant/Restrictive Food Intake Disorder (ARFID) in a Child with Previously Undiagnosed Autism Spectrum Disorder: A Case Report

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is highly prevalent in children with Autism Spectrum Disorder (ASD). While selective eating is common, Severe Acute Malnutrition (SAM) manifesting as Kwashiorkor in non-famine settings is rare. This report highlights a life-threatening presentation of nutritional deficiency driven solely by behavioral restriction. Case Presentation: A 6-year-old Thai boy presented with generalized edema, desquamating rash for 2 month. History revealed a 1-year duration of extreme food selectivity, consuming only specific brands of rice crackers and refusal of solids, coinciding with developmental regression. Physical examination revealed anasarca, “flaky paint” dermatosis, and perifollicular hemorrhages. Anthropometry showed severe wasting masked by edema. Laboratory investigations confirmed hypoalbuminemia (2.4 g/dL), anemia, and undetectable Vitamin C levels (<0.10 mg/L). Developmental assessment revealed deficits in social communication and restrictive interests, confirming a diagnosis of ASD.

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