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Histologic Investigation of Muscle Tissue in Kwashiorkor¹

1. Muscle biopsies in children with kwashiorkor reveal an increase in the number of both pale and dark nuclei of the sarcolemma, a pericapillary infiltration of the interfascicular vessels, edema, and, in more advanced cases, a fine network of connective tissue fibers in the intermysial space. This intermysial sclerosis may include some infiltrative elements (lymphocytes, more rarely histiocytes). The caliber of the muscle fibers and of the fascicles is frequently reduced. Degenerated muscle fibers occur at random. No evidence of burgeoning can be seen in any of the affected muscle fibers. The adventitial spaces of blood vessels and the small nerve fibers may show signs of edema. These findings are based upon the study of 11 cases of kwashiorkor.

2. In seven cases of cachexia due to causes other than kwashiorkor, muscle tissue showed a slight increase in the number of the pale nuclei, some septal edema, slight eosinophilia of a few muscle fibers and, rarely, a few degenerated fibers.

3. In both instances, the lesions are of the same type but they are uniformly more severe in the patients with kwashiorkor.

4. The muscle fibers themselves would appear to be the most resistant element of the fascicle. These are involved only when the edema and the fibrous changes are advanced. This occurs only in cases of kwashiorkor presenting the full clinical picture.

¹ Translated from the French by Charles M. Poser, M.D., University of Kansas Medical Center.

² Pediatric Service of the Hospital Prince Regent Charles, Usumbura, Ruanda-Urundi.

³ Laboratory of Neuropathology of the Institut Bunge, Berchem-Antwerp, Belgium.