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Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report

BACKGROUND: Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia...

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Autores principales: Takeshima, Masahiro, Ishikawa, Hiroyasu, Kitadate, Akihiro, Sasaki, Ryo, Kobayashi, Takahiro, Nanjyo, Hiroshi, Kanbayashi, Takashi, Shimizu, Tetsuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970484/
https://www.ncbi.nlm.nih.gov/pubmed/29801443
http://dx.doi.org/10.1186/s12888-018-1743-6
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author Takeshima, Masahiro
Ishikawa, Hiroyasu
Kitadate, Akihiro
Sasaki, Ryo
Kobayashi, Takahiro
Nanjyo, Hiroshi
Kanbayashi, Takashi
Shimizu, Tetsuo
author_facet Takeshima, Masahiro
Ishikawa, Hiroyasu
Kitadate, Akihiro
Sasaki, Ryo
Kobayashi, Takahiro
Nanjyo, Hiroshi
Kanbayashi, Takashi
Shimizu, Tetsuo
author_sort Takeshima, Masahiro
collection PubMed
description BACKGROUND: Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia from other types of pancytopenia, especially idiopathic aplastic anemia (IAA), has not been studied. We encountered a case of pancytopenia in a patient with AN and relatively poor nutritional status, whose hematological findings mimicked those of IAA, specifically fatty bone marrow and absence of GMT. CASE PRESENTATION: The patient was a 32-year-old woman with poorly controlled AN. At 31 years of age, her body mass index (BMI) had fallen from 17.0 kg/m(2) to below 13.8 kg/m(2). The patient presented with ongoing fatigue and thus was examined by a hematologist. Hematological findings were consistent with IAA: peripheral blood tests revealed pancytopenia, whereas the bone marrow displayed fatty replacement without GMT. Despite the absence of bone marrow features typically seen in malnutrition, the patient’s hematological abnormalities had manifested after a decrease in body weight. Thus, although the bone marrow findings indicated IAA, we considered that the nutritional etiology of pancytopenia could not be thoroughly ruled out. Using nutritional therapy alone, the hematological abnormalities improved as BMI increased to 16.5 kg/m(2). The final diagnosis was pancytopenia secondary to malnutrition because pancytopenia and fatty bone marrow improved after implementation of nutritional therapy alone. CONCLUSIONS: The present case is the first documented case of AN with pancytopenia for which bone marrow examination confirmed fatty marrow without any evidence of GMT. IAA and pancytopenia secondary to malnutrition can present the same clinical findings. This case is significant because it suggests a need to differentiate between malnutrition and IAA.
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spelling pubmed-59704842018-05-30 Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report Takeshima, Masahiro Ishikawa, Hiroyasu Kitadate, Akihiro Sasaki, Ryo Kobayashi, Takahiro Nanjyo, Hiroshi Kanbayashi, Takashi Shimizu, Tetsuo BMC Psychiatry Case Report BACKGROUND: Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia from other types of pancytopenia, especially idiopathic aplastic anemia (IAA), has not been studied. We encountered a case of pancytopenia in a patient with AN and relatively poor nutritional status, whose hematological findings mimicked those of IAA, specifically fatty bone marrow and absence of GMT. CASE PRESENTATION: The patient was a 32-year-old woman with poorly controlled AN. At 31 years of age, her body mass index (BMI) had fallen from 17.0 kg/m(2) to below 13.8 kg/m(2). The patient presented with ongoing fatigue and thus was examined by a hematologist. Hematological findings were consistent with IAA: peripheral blood tests revealed pancytopenia, whereas the bone marrow displayed fatty replacement without GMT. Despite the absence of bone marrow features typically seen in malnutrition, the patient’s hematological abnormalities had manifested after a decrease in body weight. Thus, although the bone marrow findings indicated IAA, we considered that the nutritional etiology of pancytopenia could not be thoroughly ruled out. Using nutritional therapy alone, the hematological abnormalities improved as BMI increased to 16.5 kg/m(2). The final diagnosis was pancytopenia secondary to malnutrition because pancytopenia and fatty bone marrow improved after implementation of nutritional therapy alone. CONCLUSIONS: The present case is the first documented case of AN with pancytopenia for which bone marrow examination confirmed fatty marrow without any evidence of GMT. IAA and pancytopenia secondary to malnutrition can present the same clinical findings. This case is significant because it suggests a need to differentiate between malnutrition and IAA. BioMed Central 2018-05-25 /pmc/articles/PMC5970484/ /pubmed/29801443 http://dx.doi.org/10.1186/s12888-018-1743-6 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Takeshima, Masahiro
Ishikawa, Hiroyasu
Kitadate, Akihiro
Sasaki, Ryo
Kobayashi, Takahiro
Nanjyo, Hiroshi
Kanbayashi, Takashi
Shimizu, Tetsuo
Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title_full Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title_fullStr Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title_full_unstemmed Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title_short Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
title_sort anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5970484/
https://www.ncbi.nlm.nih.gov/pubmed/29801443
http://dx.doi.org/10.1186/s12888-018-1743-6
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