M. L., seven months old, was getting "Molkenadaptierte" milk, and in
addition autolyzed yeast. On May 25th it developed nasal diphtheria,
but soon afterward did well. On June 9th it was gaining, but its
pulse was 160 and respirations 80. A few days later it developed
marked eczema about the neck and to a less extent on the back and
buttocks. The "capillary resistance test" was negative.
Cardiographic tracings showed merely a simple tachycardia. A few
days later petechial spots appeared at the site of the eczema. On
June 17th orange juice was given. The appetite improved, the
cardiorespiratory syndrome disappeared, and the child began to gain.
The eczema also cleared up rapidly without any local treatment.
We wish to draw particular attention to this skin condition, as it is
generally not mentioned, or has been regarded merely as a chance
occurrence. The report of the American Pediatric Society includes two
cases of eczema as a complicating condition. This symptom is of special
interest in view of the fact that a similar skin lesion constitutes one
of the typical signs of pellagra. In a case of infantile scurvy we have
seen an eruption at the nape of the neck which was symmetrical and
greatly resembled that of pellagra. Andrews refers to the occurrence of
eczema in his description of infantile beriberi.
In a paper published a few years ago attention was drawn by Hess and
Fish to the fact that infantile scurvy frequently is associated with the
exudative diathesis of Czerny, a pathological condition which
predisposes to the development of exudations of the skin and the mucous
membranes. Infants suffering from this condition--intertrigo, eczema,
recurrent bronchitis--seem to be particularly susceptible to scurvy and
to develop it more quickly than others.
As is well known, _edema_ constitutes a not infrequent symptom of adult
scurvy. It has not, however, been accorded any place in the
symptomatology of infantile scurvy. We do not refer to the edema in
connection with subperiosteal hemorrhage or separation of the epiphyses
of the long bones, but a mild and peculiar form which is seen early in
the disease. It involves most regularly the upper eyelids, and the
legs--especially the skin covering the lower part of the tibiæ. In the
latter site it differs from edema as usually encountered, in that it
does not pit on pressure; it is firm, tense, causing some glossiness of
the overlying skin, which is rendered difficult to wrinkle or to pinch
between the fingers. Not infrequently the skin is slightly reddened, a
sign of interest, in view of a similar, although much more intense,
hyperæmia seen in pellegra.
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