A twenty-year-old womanwith anorexia nervosa (body mass index=l l) suffered from severe liver dysfunction (aspartate aminotransferase 5,000 IU//, alanine aminotransferase 3,980 IU//, prothrombin time 32%), hypoglycemia (serum glucose 27 mg/dl), and pancreatic dysfunction (amylase 820 IU//, lipase 558 IU//). She fell into a depressive state with irritability, which was not improved by intravenous glucose. Despite treatment with plasmapheresis for the liver dysfuncttion, she subsequently developed pulmonary edema, acute renal failure, gastrointestinal bleeding, and disseminated intravascular coagulation. Hemodialysis, mechanical ventilation and drug therapy including prednisolone, prostaglandin E19 and branched-chain amino acid, improved her critical condition. In this case, malnutrition mayhave been the cause for the liver dysfunction and subsequent complications. (Internal Medicine 38: 575-579, 1999)