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April 1988

Generalized Weight Loss in a Child

Author Affiliations

Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock

Arch Dermatol. 1988;124(4):575-576. doi:10.1001/archderm.1988.01670040077029

REPORT OF A CASE  An 8-year-old girl developed malaise, a sore throat, an enlarged tender liver, and adenopathy. Laboratory tests demonstrated elevated liver enzyme levels, a positive streptococcal screen, and a negative viral hepatitis profile (hepatitis B surface antigen, anti-hepatitis B surface antigen, anti-hepatitis B core antigen, and hepatitis A virus antibody). Six months later the patient developed severe generalized weight loss, most apparent on the lower extremities, polydipsia, and polyuria. A family history was noncontributory. On physical examination she had a "muscular habitus" with absence of subcutaneous fat over her entire body (Fig 1). Superficial veins were prominent on the legs (Fig 2). Her face revealed moderate subcutaneous atrophy with a few telangiectasias. On palpation, lymph nodes and liver were both slightly enlarged. The findings of examination of the genitalia were normal. There was no hypertrichosis, hyperpigmentation, or acanthosis nigricans noted. Laboratory data revealed elevated triglyceride levels, hyperinsulinemia,