A Hepatic Manifestation of Anorexia Nervosa

A 30-year-old woman with a history of anorexia nervosa was admitted with weight loss, hypoglycaemia and electrolyte disturbances. During her admission, transaminases peaked at ALP 457 U/l, AST 817 U/l and ALT 1066 U/l. Imaging and laboratory findings were unrevealing, and she declined liver biopsy. Nutrition was introduced via a nasogastric tube and she demonstrated improvement in her laboratory values over several weeks. Her transaminitis was determined to be secondary to severe malnutrition, which has been previously described, but cases with such profound transaminitis are less common. Studies have demonstrated hepatic autophagocytosis as the likely cause. LEARNING POINTS: Anorexia nervosa can cause severe liver injury as manifested in AST and ALT levels in the thousands. The slow reintroduction of enteral feeding can reverse liver injury. The mechanism is unclear but autophagocytosis of liver cells likely contributes to this phenomenon.