Inducible syncope in anorexia nervosa: two case reports

OBJECTIVE: Syncope is a potentially dangerous symptom of anorexia nervosa that is usually attributed to bradycardia, dehydration, or hypoglycemia. METHODS: This study describes two adolescents, one male and one female, with recurrent self-induced syncope associated with isometric exercise. RESULTS: In one patient, Holter monitoring showed that isometric exercise led to increasing bradycardia followed by asystolic pauses accompanied by presyncopal symptoms. DISCUSSION: We hypothesize that inducible syncope in these two patients is due to increased vagal tone and baroreceptor sensitivity. Physicians should be aware that patients with anorexia nervosa may be able to induce syncope with isometric exercise and that this potentially dangerous behavior needs to be addressed during treatment.     

Acute liver damage in anorexia nervosa

We report a case of a 26-year-old White woman with a history of anorexia nervosa who developed severe liver damage and multiorgan dysfunction. At admission to our medical unit, her body mass index (BMI) was 10.8. Biochemical evaluation showed a marked increase in serum levels of aspartate aminotransferases (AST = 9,980 IU/L), alanine aminotransferase (ALT = 3,930 IU/L), amylase (1,002 IU/L), lipase (1,437 IU/L), creatine phosphokinase (CPK; 783 IU/L), and lactate dehydrogenase (LDH = 6,830 IU/L). Glomerular filtration rate was reduced (35 ml/min), reflecting dehydration and prerenal azotemia. No other cause of acute liver damage except malnutrition was evidenced. Hydration and nutritional support were the unique medical treatment. A rapid recovery occurred in few days and all laboratory data were normal at discharge after a 37-day hospitalization.     

Salinophagia in anorexia nervosa: Case reports

We report two cases of pathological ingestion of salt as a feature of anorexia nervosa, which we have previously termed “salinophagia.” Both cases were young women with anorexia nervosa of the purging subtype and of sufficient severity to necessitate inpatient treatment. In both instances, excessive quantities of salt were ingested in the context of treatment programs requiring nutritional rehabilitation, and motivated by a wish to despoil the food and render it distasteful, to rob its ingestion of any hedonic qualities. In one instance, this behavior pattern was imitated by other patients on the unit. Having first briefly described salinophagia in 1999, the first author has received considerable correspondence from other specialists suggesting that this is not an isolated phenomenon. The issues of phenomenology and treatment are further discussed. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord, 2010     

Weight fluctuations during early refeeding period in anorexia nervosa: case reports

OBJECTIVE: This study reports wide weight fluctuations during a week of early refeeding for 2 patients with anorexia nervosa and discusses possible mechanisms. METHOD: Laboratory tests that consist of complete blood count, biochemistry panel, and serum protein levels were performed. Fluid intake and daily urine output of the patients were measured. RESULTS: Laboratory tests were within normal limits for both patients except for leukopenia in one patient. By the end of the Week 1, both patients had achieved significant weight gain (9 kg and 3 kg, respectively) concurrent with edema. Their daily fluid intake and urine output measurements indicated increased total body water levels. DISCUSSION: Although the pathophysiology of refeeding edema is not entirely understood, it is well known that insulin induces sodium retention by increasing distal tubular sodium reabsorption. In our patients, refeeding-induced insulin secretion may be chiefly responsible for the edema and weight gain during the early refeeding period.     

Delayed detection of pregnancy in patients with anorexia nervosa: Two case reports

Pregnancy in patients with anorexia nervosa is rarely suspected. Amenorrhea is invariably present, often accompanied by sensations such as a bloated abdomen, nausea, vomiting, and fatigue. The detection of conception in anorectic patients is often delayed. Two extreme cases of belated recognition of pregnancy (at Weeks 25 and 26) in anorectic patients are described: Both had been amenorrheic prior to conception, had no notion of pregnancy, and in both, discovery was incidental. Termination of pregnancy, requested by one of the patients, was unfeasible at this gestational age. Pregnancy in patients with eating disorders is elusive, prone to complications, and should be considered when symptoms are suggestive. © 1996 by John Wiley & Sons, Inc.     

Anorexia nervosa and celiac disease: two case reports

OBJECTIVE: Anorexia nervosa (AN) has been reported to be associated with several chronic medical illnesses. In this study, we report two cases of women suffering from AN and celiac disease. The former received the diagnosis of celiac disease before the onset of the eating disorder. For the latter, the diagnosis of celiac disease followed that of AN. Authors discuss the complex relationships between celiac disease and AN. They suggest that in the first case the dietary restriction could act as a trigger for the eating disorder, whereas in the second case, the onset of celiac disease could have exacerbated the clinical symptoms of AN.     

Severe neutropenia with gelatinous bone marrow transformation in anorexia nervosa: a case report

A 28-year-old woman with a history of anorexia nervosa was admitted with excessive weight loss, edema, and amenorrhea. She had lost 34% of her previous body weight within 2 years, and her body mass index was 12.3 kg/m(2). The leukocyte count on admission was 2150/microl and gradually decreased to 980/microl (neutrophils; 276/microl). Bone marrow biopsy disclosed gelatinous transformation with hypocellularity. After the patient was treated with intravenous nutritional support, the severe neutropenia improved to the level on admission. Hematological abnormalities seem to be common in anorexia nervosa, but severe neutropenia with gelatinous bone marrow transformation has rarely been reported.     

The psychiatric history of anorexia nervosa and bulimia nervosa: Weight concerns and bulimic symptoms in early case reports

British, French, American, German, and Italian historical medical reports on possible cases of anorexia nervosa and bulimia nervosa were critically reevaluated in order to trace the history of weight concerns, binge eating, and methods of food reversal like self-induced vomiting in these texts. It is argued that weight concerns are a new phenomenon in prolonged extreme fasting and has superseded traditional ascetic motivations for fasting from the first use of the term anorexia nervosa on. Binge eating, or bulimia as a symptom, on the other hand, has been known ever since ancient times; what is new here is its combination with methods of food reversal, which are motivated by concerns about weighing too much. This combination, bulimia nervosa (DSM-III-R), was first described in cases of primary anorexia and started becoming more frequent only in the 1940s. First accounts of possible cases of bulimia nervosa at normal body weight were published in the 1930s. Methodological problems of retrospective diagnosing and factors inherent to the history of medicine which might have influenced the history of medical writing about eating disorders are discussed.     

Bulimia nervosa and misuse of orlistat: two case reports.

OBJECTIVE: Orlistat (tetrahydrolipstatin) is an intestinal lipase inhibitor that was approved recently for the management and treatment of obesity. This is the first report of the misuse of orlistat in two normal-weight purging bulimia nervosa (BN) patients. METHOD AND RESULTS We report two diagnosed cases of BN in two Spanish women who used orlistat as a purging mechanism after binge episodes. In both cases, the onset of the eating disorder was in adolescence. From the beginning, a restrictive diet, binging, and purging behavior (vomiting and using laxatives) were present. Both patients misused this substance as their only purging mechanism after every binge episode. CONCLUSION: BN patients have used many substances and bizarre behaviors as purging mechanisms. Nevertheless, to the authors' knowledge, these are the first reported cases of orlistat misuse as the only purging mechanism in two BN patients.     

Blood-letting in anorexia nervosa: a case study

BACKGROUND: Deliberate blood-letting has been characterized as an alternative to purging behavior in bulimia. METHOD: We describe a female healthcare worker with an 8-year history of restrictive anorexia nervosa, who initially presented with anemia, using blood-letting, cold baths, and starvation to control her mental state. RESULTS: In contrast with the previous cases of bulimia, the aim of blood-letting in this case of anorexia nervosa was to achieve anemia. She compared the psychic correlates of anemia to emaciation, rather than to deliberate self-harm or purging. DISCUSSION: We note that mainstream 19th century psychiatry prescribed "baths, blood-letting and diet" as a treatment of "madness." Copyright 2000 by John Wiley & Sons, Inc.     

Case reports of olanzapine treatment of anorexia nervosa

Two females with severe anorexia nervosa were treated with olanzapine in open trials. Olanzapine was tried because it has caused weight gain in other patient groups. Both anorexic patients had a chronic illness and had failed multiple other treatments. Olanzapine administration was associated with weight gain and maintenance as well as reduced agitation and resistance to treatment. These case histories support further exploration of this class of drugs in anorexia nervosa.     

Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa: case reports

OBJECTIVE: A recent case report suggested that olanzapine resulted in improved weight gain and maintenance, as well as decreased anxiety and agitation, for two hospitalized inpatients with anorexia nervosa (AN). However, a subsequent larger case study did not show a relationship between the use of olanzapine and rate of weight gain among a primarily adult population. The aim of this case report was to clinically examine the therapeutic benefit and tolerability of olanzapine as an adjunctive treatment for four children with AN in a pediatric inpatient setting. RESULTS: Olanzapine use was associated with considerable weight gain and maintenance, with an average rate of weight gain during hospitalization of 0.99 kg per week. In addition to weight gain, olanzapine was associated with a clinically notable decrease in levels of agitation and premeal anxiety and almost immediate improvement in sleep, general functioning, and overall compliance with treatment. Olanzapine was also well tolerated in these young patients. DISCUSSION: These case report findings warrant more controlled research, including randomized controlled studies, to better determine the therapeutic benefits and safety of olanzapine use in children with AN.     

Three case reports on the relationship between anorexia nervosa and obsessive compulsive disorder

The literature has demonstrated that both food-related and non food-related obsessions and compulsions are common in patients with eating disorders and that eating disorders are common in patients with obsessive-compulsive disorder (OCD). It has become increasingly important, therefore, to evaluate the clinical and etiological relationships between these disorders. The authors present three patients with anorexia nervosa and obsessive-compulsive disorder. In two of the cases, OCD symptoms preceded onset of the eating disorder by several years. In the third case, OCD symptoms began after the onset of weight loss. In all three cases, obsessive-compulsive symptoms had a significant effect on attempts to treat the eating disorder. Medication, utilized in one of the three patients, was helpful in treatment of the OCD but did not have a major effect on the eating disorder. There remains much to learn about the epidemiology, etiology, treatment and outcome of those who have comorbid eating disorders and OCD. These cases highlight some of the issues encountered in management of patients with these combined conditions.     

Barrett's esophagus in anorexia nervosa: A case report

Barrett's esophagus (BE) is a metaplastic lesion that may result from long‐lasting gastroesophageal reflux and it is an established precursor of esophageal adenocarcinoma. There are reports of an increased prevalence of BE, and eventually esophageal adenocarcinoma, in patients with eating disorders characterized by purging behaviors like those with bulimia nervosa (BN). Among patients with eating disorders, those affected by anorexia nervosa binging purging subtype (ANBP), are behaviorally very similar to those with BN, but to our knowledge there are no data in literature about BE in patients with ANBP. We present the case of a 37‐year‐old female with a 20‐year history of ANBP in comorbidity with bipolar disorder, who developed a BE requiring multi‐specialistic intervention. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:147–150)     

Sexual abuse antecedent to anorexia nervosa,bulimia, and compulsive overeating: Three case reports

This paper examines the role of childhood sexual abuse antecedent to anorexia nervosa, bulimia, and compulsive overeating. Three case reports are used to illustrate the development of eating disorders in the context of sexual abuse. Implications are discussed in terms of the need for professionals to develop sensitivity to this potential antecedent in order to apply appropriate intervention strategies with sexual abuse victims seeking treatment for an eating disorder.     

Severe anorexia nervosa associated with osteoporotic-linked femural neck fracture and pulmonary tuberculosis: a case report

We report a case study of a 38-year-old woman who had been suffering from anorexia nervosa (AN) since the age of 26. Before admittance to our clinic, she weighed 23.8 kg (at a height of 164 cm, 8.8 body mass index [BMI]) but still carried out strenuous physical activities. After good psychotherapeutic response and weight gain (34.4 kg), she accidentally fell and broke her femoral neck-favored as it was by osteoporosis. The X-ray taken before dynamic hip screw implantation coincidentally showed signs of pulmonary tuberculosis (TB), which could then be proven by computed tomography (CT) scans and cultures from a bronchoscopy. Other than lack of appetite and loss of weight, which we attributed to AN, there were no other clinical or biochemical indicators which could have pointed to an earlier TB diagnosis. As a result, the need for screening procedures is discussed. The manifestation of TB during the first weight gain after 12 years of severe malnutrition, during which there were no serious infections, seems to endorse former observations that AN patients appear to be "resistant" to some extent against infectious diseases, a "protection" which may be lost with convalescence and weight gain.