A Rare Case of Malnutrition Hepatitis in a Patient with Anorexia Nervosa

Anorexia nervosa (AN) is a common eating disorder, particularly in women, with a lifetime prevalence estimated to be 0.3– 0.9%. This disorder is associated with numerous medical complications (cardiovascular, endocrine disorders, electrolyte and hematopoietic abnormalities, amenorrhea, and osteoporosis), among which changes in liver tests are frequent. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. The exact mechanism of liver damage has not been identified; however, some have hypothesized autophagy (programmed cell death) as a possible cause of hepatocyte damage. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation. We report here, the case of a 58 year old lady with a background of anorexia nervosa who developed severe acute liver failure with histological evidence of starvation hepatitis while on admission for a right hip osteomyelitis, which was slowly reversed after careful and gradual nutritional replacement.