Furunculosis as a presentation of PVL MRSA infection Repetitive abcedations and furuncles in young patients are unusual. When occurring in an immunocompetent subject, PVL-SA infection should be considered. In this case report, the history of a female patient with severe PVL-SA infection is reported. An overview of the diagnosis and treatment recommendations is given.

Impending liver failure and severe hypoglycemia in a young woman with anorexia nervosa Anorexia nervosa (AN) is a complex psychosomatic disease that may lead to life-threatening conditions such as acute liver failure and hypoglycemia. This article discusses the case of a 28-year-old woman with a BMI (weight/length2) of 10.6 kg/m2 who presented generally unwell to the emergency department with diffuse abdominal cramps. During her hospitalization, she repeatedly developed a profound hypoglycemia (which was associated with a significant decline in the level of consciousness). She also showed a significant increase of her transaminases to a maximum alanine aminotransferase (ALT) of 1,219 U/L and a maximum aspartate aminotransferase (AST) of 512 U/L. Enteral feeding was gradually started, resulting in both the prevention of another episode of hypoglycemia and normalisation of the transaminases. Mildly elevated liver enzymes are frequent in AN. A rise of ALT/AST, however, only occurs in patients with a very low BMI and is a sign of impending liver failure. Most likely, this is caused by autophagy-induced hepatitis, although this remains a subject of debate. Severe AST/ALT abnormalities are associated with the development of a profound hypoglycemia due to impairment of the gluconeogenesis and the limited reserve of glycogen in the hepatocytes. Both impending liver failure and hypoglycemia can best be treated by supervised nutritional rehabilitation.