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Forty-eight cases of fatty liver disease in infancy coming to autopsy over the past 10 years at Gorgas Hospital are reported. The diagnosis of this condition is extremely difficult clinically; liver biopsy is the only certain way of making the premortem diagnosis. In Panama, vomiting, diarrhea and fever are the most frequent presenting complaints. Physical findings of help are the stunted growth, fever, and possibly enlarged liver. Other findings seen commonly in the African cases, such as edema, glossitis and dermatosis, are usually not, seen. The essential pathologic finding is a markedly fatty liver. Pancreatic changes consisting of acinar atrophy were seen in some cases. The cause of the deficiency state appears to be an inadequate protein intake, and will not be simple to deal with, as poverty and ignorance, rather than neglect, would seem to be responsible for this disease. The prognosis is extremely poor, only 11 of the 48 patients surviving for more than 24 hours after medical attention was sought. It is probable that fatty liver disease in infants is relatively common in Panama but almost completely overlooked clinically.

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