Why do individuals with anorexia die? A case of sudden death

OBJECTIVE: The mechanism of death in anorexia nervosa (AN) is unclear. METHOD: We present a case of sudden death in AN with unexpected autopsy findings. A 36-year-old woman with long-standing AN presented to the eating disorders unit. She was severely underweight with a body mass index of 12.5. Ten days after admission, she went into coma with no obvious precipitant. RESULTS: Clinical examination and investigations failed to reveal its cause. Despite attempts at resuscitation, she died the following morning. A postmortem examination revealed multiple bilateral pulmonary thromboemboli and bilateral calf vein thrombosis. CONCLUSION: This case illustrates that in AN, pathology may not manifest with obvious clinical features. A high level of clinical vigilance is required. The cause of death in AN cannot reliably be established from antemortem clinical features. We recommend that any AN death be reported and that, where possible, an autopsy be performed. This may lead to advances in knowledge and treatment practices.