Failure to Thrive: An Expanded Differential Diagnosis

Abstract

The patient is a term 6-month-old male, who presented with failure to thrive since birth. History was remarkable for suspected milk and soy protein allergy, gastroesophageal reflux, constipation, and abdominal distension that was present since birth. He was losing weight despite oral intake of over 100 kcal/kg per day. Prior workup including laboratory studies, abdominal X-ray, upper gastrointestinal series with fluoroscopy, barium enema, and abdominal ultrasound were all within normal limits. The patient's history, diagnostic evaluation, and final diagnosis are revealed. This case highlights a rare condition presenting as failure to thrive, a common problem with a wide differential diagnosis.

Keywords: Wolman's disease; failure to thrive.

Fig. 1

Abdominal X-ray is shown below. Abdominal X-ray was read as “bilateral adrenal calcifications, marked by arrows.”

Fig. 2

( A–C ) An abdominal computed tomography was then obtained, which showed hepatosplenomegaly ( A ) and hepatic steatosis in association with bilateral adreniform enlargement and stippled calcification of the adrenal glands ( B ) without focal adrenal mass to suggest neoplasm.

Fig. 3

( A–C ) Growth charts for the patient for weight, head circumference, and length. Open diamonds represent the values on admission; x represents all other measurements.