Marked ascites and serum carbohydrate antigen (CA) 125 elevation in a patient with anorexia nervosa

Suwabe, Tatsuya; Taguchi, Manabu; Takeshita, Akira; Ozawa, Yasunori

doi:10.1002/eat.20154

Cited by 2 publications

(2 citation statements)

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“…Moderate ascites because of acute liver cell damage was observed in 4 of 12 patients with AN. [ 3 ] Marked ascites has been reported in 3 cases of AN with hypoalbuminemia, including one developing massive ascites and moderate pedal edema with elevated CA-125, [ 4 ] another developing abdominal pain and ascites due to chronic pancreatitis, [ 15 ] and 2 of 3 women with AN developing portal hypertension and gastroesophageal varices but pathologically mild pericellular fibrosis. [ 16 ] In our case, the aforementioned common causes for massive ascites in AN were not found.…”

Section: Discussionmentioning

confidence: 99%

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Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl

Fan¹,

Lin²,

Chen³

et al. 2020

Medicine

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Rationale: Anorexia nervosa (AN) is a serious eating disorder associated with a distorted body image. Hypercholesterolemia has been found in patients with AN but the mechanism of hyperlipidemia in AN remains little known. Ascites in patients with AN has been attributed to hypoalbuminemia and liver diseases, but massive ascites without the aforementioned etiologies has never been reported in AN. Patient concerns: An 11-year-old girl was admitted for exclusion of organic underlying diseases due to severe body weight loss (18% within 3 weeks), poor appetite, and hypercholesterolemia (274 mg/dL). She complained of heartburn sensation, nausea, vomiting, constipation, and postprandial dull abdominal pain with fullness. Diagnoses: The patient's condition met with all 3 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for diagnosing AN. On admission, her total cholesterol level was 337 mg/dL and hypocomplementemia (C3 55.5 mg/dL) was also found. Abdominal sonography and computed tomography scans showed massive ascites. However, neither proteinuria nor hypoalbuminemia was found. Upper gastroduodenal endoscopy showed chronic superficial gastritis and colonoscopy revealed negative findings. Ascites obtained by paracentesis demonstrated a transudate without bacterial infection, tuberculosis, or pancreatitis. Exploratory laparoscopy showed nonpurulent ascites. However, biopsies from the small intestine, mesentery, and liver showed chronic inflammation and fibrosis. Interventions: The intensive nutritional therapy by increasing total energy intake stepwise with a combination of high-energy formula and her favorite foods. Outcomes: Her hypercholesterolemia, hypocomplementemia, and massive ascites resolved after her weight was restored. She developed binge eating with continuous weight gain after discharge. Her weight significantly increased to an obese level (body mass index [BMI] 25.9 kg/m 2 ) after loss to follow-up for 4 years until she returned to our emergency room due to suicide attempt. Conclusion: Diagnostic crossover between subtypes in anorexia nervosa might be a potential risk factor for illness severity and poor prognosis. AN can manifest as massive ascites with normal albumin concentrations that could possibly be due to chronic inflammation of the intestinal serosa, mesentery, and peritoneal surface of the liver.

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Section: Discussionmentioning

confidence: 99%

“…[ 2 ] Additionally, ascites in patients with AN has been attributed to hypoalbuminemia and liver diseases. [ 3 , 4 ] However, massive ascites without the aforementioned etiologies has never been reported in AN.…”

Section: Introductionmentioning

confidence: 99%

Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl

Fan¹,

Lin²,

Chen³

et al. 2020

Medicine

View full text Add to dashboard Cite

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Comparative study of rate of weight loss among premorbid and healthy restrictive eaters

Kovalchik

2008

Eat Weight Disord

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Initial body mass index (BMI) and rate of weight loss are compared between cohorts of pathological and healthy dieters. The eating disordered sample consists of young adults reported in case studies in the past ten years with a primary diagnosis of anorexia nervosa (AN). The healthy dieters were adolescents who participated in the National Longitudinal Survey of Adolescent Health and indicated at the time of study enrollment that they were trying to lose weight. At diet initiation, the anorexic sample had a mean BMI (kg/m2) of 20.5 while the healthy dieters had a mean of 24.8. The median rate of weight loss was -1.87 kg per month (1 pound per week) for individuals later diagnosed with AN, while the median weight change was 0.24 kg per month for the Add Health dieters, reflecting an actual gain of 0.13 pounds per week. These findings suggest that measurable physiological characteristics during the early phase of a diet could be predictive of pathological food restriction.

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Marked ascites and serum carbohydrate antigen (CA) 125 elevation in a patient with anorexia nervosa

Cited by 2 publications

References 9 publications

Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl

Anorexia nervosa manifesting as massive ascites, hypercholesterolemia, and sequential binge eating in an 11-year-old girl

Comparative study of rate of weight loss among premorbid and healthy restrictive eaters

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