A case of anorexia nervosa with severe liver dysfunction and pancytopenia

A 18 year old girl was admitted to our hospital due to anorexia nervosa (AN) in March 1993. She hardly ate anything, and lost her weight from 27.8 kg to 25.8 kg in 10 days. On 15th day, she suffered from severe liver dysfunction due to malnutrition. On 21th day, GOT, GPT, LDH and ALP rose to 4,210 U/l, 2,482 U/l, 2,448 U/l and 1,920 U/l respectively. At the same time she showed pancytopenia. Peripheral WBC and Hb were reduced to 1,400/mm³ and 7.1 g/l respectively, indicating normochromic normocytic anemia. Platelet was also reduced to 2.9 x 10⁴/mm³, but prothrombin time and active partial thromboplastin time were normal. She was treated with mainly intravenous hyperalimentation (IVH), then she recovered after about two months. Thereafter she was treated with combination of behavior therapy and psychotherapy and discharged after five months. AN sometimes complicates liver dysfunction, but a severe case is rare. We investigated some hypotheses of this mechanism referring to previous reports about severe liver dysfunction with AN. And we discussed the relationship between liver dysfunction and pancytopenia.