Prosthetic valve endocarditis caused by Propionibacterium acnes

nervosa-namely, the low body weight, the resistance to eating, the admission that this had been a chronic condition, the lack of children, and the possibility of sexual difficulties in the marriage.Our patient would have been 25 years old when the war began, and it is possible that he already had chronic anorexia.His experience as a prisoner of war may have been used retrospectively to cover up the underlying psychiatric illness.The aetiology of anorexia nervosa remains uncertain.Important life events may act as precipitants and have been found in the backgrounds of many patients with anorexia.The physical and psychological stresses among prisoners of the Japanese during the second world war have been described.' The clinical signs in anorexia nervosa are due to a combination of energy and protein deficiency and could lead to severe cachexia.The predominant atrophy of type two muscle fibres seen in our patient was similar to that seen in women with anorexia nervosa and severe weight loss.2Neuropathy and myopathy have also been described.3Anorexia nervosa is often a relapsing and remitting condition lasting for many years.Our patient is of interest as there is little information about long term outcome in anorexia nervosa.1 Tennant CC, Goulston K, Dent OF.The psychological effects being a prisoner of war: forty years after release.