Severe Starvation-Induced Hepatocyte Autophagy as a Cause of Acute Liver Injury in Anorexia Nervosa: A Case Report

Introduction. Mild elevation of transaminase may be observed in anorexia nervosa, but acute liver injury is uncommon. A complex programmed cell death in response to starvation, called autophagy, has been described in experimental and human studies.Case Presentation. A 24-year-old woman suffering from anorexia nervosa was hospitalized for severe malnutrition. At admission, there were biological signs of acute liver injury but no electrolytic imbalance. After having ruled out the most common causes of liver injury, the patient was carefully refed. As liver tests remained abnormal, liver biopsy was performed. At histology and electron microscopy, numerous signs suggestive of starvation-induced hepatocyte autophagy were found.Discussion. Severe starvation can be associated with acute liver injury that is slowly reversible with careful enteral nutrition. In this clinical situation, profound hepatic glycogen depletion in association with autophagy appears as the leading cause of liver injury.

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Hepatoprotective effects of ginsenoside Rk3 in acetaminophen-induced liver injury in mice by activation of autophagy

Food & Function ◽

10.1039/d1fo02081a ◽

2021 ◽

Author(s):

Linlin Qu ◽

Rongzhan Fu ◽

xiaoxuan Ma ◽

Daidi Fan

Keyword(s):

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Liver Injury ◽

Common Causes ◽

Hepatoprotective Effects

Acetaminophen (APAP)-induced acute liver injury (AIALI) is one of the most common causes of acute liver failure. Owing to the limitations of N-acetylcysteine (NAC), which is the only antidote currently...

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Liver Autophagy in Anorexia Nervosa and Acute Liver Injury

BioMed Research International ◽

10.1155/2014/701064 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 20

Author(s):

Marouane Kheloufi ◽

Chantal M. Boulanger ◽

François Durand ◽

Pierre-Emmanuel Rautou

Keyword(s):

Cell Death ◽

Anorexia Nervosa ◽

Liver Injury ◽

Acute Liver Injury ◽

Protective Mechanism ◽

Liver Insufficiency ◽

Electron Microscopy Analysis ◽

Microscopy Analysis ◽

Rescue Mechanism ◽

Liver Cell Death

Autophagy, a lysosomal catabolic pathway for long-lived proteins and damaged organelles, is crucial for cell homeostasis, and survival under stressful conditions. During starvation, autophagy is induced in numerous organisms ranging from yeast to mammals, and promotes survival by supplying nutrients and energy. In the early neonatal period, when transplacental nutrients supply is interrupted, starvation-induced autophagy is crucial for neonates’ survival. In adult animals, autophagy provides amino acids and participates in glucose metabolism following starvation. In patients with anorexia nervosa, autophagy appears initially protective, allowing cells to copes with nutrient deprivation. However, when starvation is critically prolonged and when body mass index reaches 13 kg/m2or lower, acute liver insufficiency occurs with features of autophagic cell death, which can be observed by electron microscopy analysis of liver biopsy samples. In acetaminophen overdose, a classic cause of severe liver injury, autophagy is induced as a protective mechanism. Pharmacological enhancement of autophagy protects against acetaminophen-induced necrosis. Autophagy is also activated as a rescue mechanism in response to Efavirenz-induced mitochondrial dysfunction. However, Efavirenz overdose blocks autophagy leading to liver cell death. In conclusion, in acute liver injury, autophagy appears as a protective mechanism that can be however blocked or overwhelmed.

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Bicalutamide-Associated Acute Liver Injury and Migratory Arthralgia: A Rare but Clinically Important Adverse Effect

Case Reports in Gastroenterology ◽

10.1159/000485175 ◽

2018 ◽

Vol 12 (2) ◽

pp. 266-270 ◽

Cited By ~ 1

Author(s):

Helga M. Gretarsdottir ◽

Elin Bjornsdottir ◽

Einar S. Bjornsson

Keyword(s):

Prostate Cancer ◽

Liver Injury ◽

Causality Assessment ◽

Acute Liver Injury ◽

Assessment Method ◽

Hepatitis Viruses ◽

Drug Induced ◽

History Of ◽

Upper Abdomen ◽

Liver Tests

We describe a case of acute liver injury and migratory arthralgia in a patient receiving bicalutamide treatment for prostate cancer. A 67-year-old male with metastatic prostate cancer presented with a 6-day history of migratory arthralgia. He had been undergoing treatment with bicalutamide for 4 months; 3 weeks prior to symptom appearance the bicalutamide dose had been increased. He had no other symptoms. Liver tests and inflammatory markers were markedly elevated. Serology for hepatitis viruses A, B, and C, CMV, and EBV and autoimmune causes were all negative, and an ultrasound of the upper abdomen was normal. There was no history of blood transfusion, intravenous drug abuse, or alcohol abuse. Due to the suspicion of a drug-induced symptomatology, bicalutamide was discontinued and the patient started on 30 mg prednisolone daily. Three weeks later he was symptom free and after 6 weeks his liver tests were almost normal. The Roussel Uclaf Causality Assessment Method (RUCAM) suggested a high probability of liver injury. Bicalutamide has very rarely been reported as a causative agent for liver injury and to our knowledge never for migratory polyarthralgia. The migratory polyarthralgia was attributed to bicalutamide due to the absence of other etiological factors and the disappearance of symptoms after discontinuation of the drug. To our knowledge, this is the first published case report of migratory arthralgia and concomitant liver injury attributed to bicalutamide.

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Acute liver injury and anorexia nervosa: a case report

Italian Journal of Medicine ◽

10.4081/itjm.2019.1135 ◽

2019 ◽

Vol 13 (2) ◽

pp. 128-131

Author(s):

Simona Pascolini ◽

Michele Cevolani ◽

Federico Lari ◽

Luigi Muratori ◽

Marco Lenzi

Keyword(s):

Body Weight ◽

Anorexia Nervosa ◽

Liver Injury ◽

Parenteral Nutrition ◽

Nutritional Assessment ◽

Acute Liver Injury ◽

Transaminase Level ◽

Progressive Increase ◽

Psychiatric Institute ◽

History Of

Anorexia nervosa is an eating disorder characterized by restriction of energy intake leading to a significant decrease in body weight. While it is primarily a psychiatric disorder, numerous medical complications can occur. In this article we describe a case of a 25-year-old woman with a 12-year history of severe restrictive anorexia nervosa that was referred to the Emergency Service of our Hospital, transferred from a psychiatric institute, for severe weight loss, dehydration, and progressive increase in transaminases. During the hospital stay she developed an acute liver injury with an increase in transaminase level up to 40× the ULN. Infective and immunological causes of acute hepatitis were excluded. In the suspect of severe starvation acute liver injury, we performed a nutritional assessment and started parenteral nutrition. After 15 days of parenteral nutrition, she gained 2.5 kg of body weight and liver tests were drastically reduced and nearly normal.

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Acute Liver Injury Associated with Anorexia Nervosa

Journal of Gastroenterology and Hepatology Research ◽

10.17554/j.issn.2224-3992.2017.06.733 ◽

2017 ◽

Vol 6 (6) ◽

pp. 2498-2501

Author(s):

Omar I. Massoud ◽

◽

D. Ralph Crowe

Keyword(s):

Anorexia Nervosa ◽

Liver Injury ◽

Acute Liver Injury

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Cerebellar Tonsillar Herniation in Sudden Death of An Adolescent Anorexia Nervosa Patient: A Case Report.

10.21203/rs.3.rs-951351/v1 ◽

2021 ◽

Author(s):

Tasuku Kitajima ◽

Ryoko Otani ◽

Naho Matsushima ◽

Naoki Matsubara ◽

Takeshi Inoue ◽

...

Keyword(s):

Anorexia Nervosa ◽

Sudden Death ◽

Cardiopulmonary Arrest ◽

Autism Spectrum ◽

Severe Malnutrition ◽

Tonsillar Herniation ◽

Autopsy Imaging ◽

Case Presentation ◽

Cerebellar Tonsillar Herniation ◽

Unexpected Findings

Abstract Background: Anorexia nervosa not only results in severe malnutrition but also carries a high risk of sudden death. Although fatal arrhythmias are the most common cause of sudden death, it is often unclear what exactly causes them. To the best of our knowledge, there have been no reports of cerebral herniations in patients with anorexia nervosa.Case presentation: A 17-year-old adolescent girl with neuropathy and autism spectrum disorder was admitted to the pediatric ward for extreme weight loss. Eight hours after admission, she suddenly went into cardiopulmonary arrest and died despite resuscitation. A postmortem autopsy revealed the unexpected findings of generalized severe cerebral edema and cerebellar tonsillar herniation.Conclusion: Intracranial hypertension may need to be considered when the condition of patients with anorexia nervosa suddenly worsens during refeeding periods. Postmortem autopsy and autopsy imaging are recommended to determine the exact cause of sudden death.

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Levothyroxine-induced liver injury followed by complete recovery upon cessation of the drug: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2244-z ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Abbas F. Hlaihel ◽

Mudher Z. H. Al-Khairalla

Keyword(s):

Adverse Effect ◽

Case Report ◽

Liver Injury ◽

Complete Recovery ◽

Diagnostic Methods ◽

Intrinsic Activity ◽

Present Case Report ◽

Case Presentation ◽

Appropriate Treatment ◽

Liver Tests

Abstract Background Levothyroxine is a synthetic thyroxine and is the treatment of choice for hypothyroidism. It is a prohormone with minimal intrinsic activity. The drug is de-iodinated in peripheral tissue to form triiodothyronine, which is the active thyroid hormone. On initiation of treatment, levothyroxine is titrated, and usually it is extremely well tolerated in the vast majority of patients. We report a case of a patient with self-limiting levothyroxine-induced liver injury, a rare adverse effect of this drug. Case presentation We report a case of a 34-year-old Mediterranean woman diagnosed with post-thyroidectomy hypothyroidism. She was commenced on levothyroxine and developed liver injury confirmed by noninvasive liver investigations. Complete recovery of the patient’s liver tests occurred upon cessation of the drug. Triiodothyronine was an appropriate treatment alternative. Conclusion Levothyroxine-induced liver injury is a rare, and in the present case report, a self-limiting, adverse effect. The diagnosis of our patient was confirmed via noninvasive diagnostic methods. Knowledge of this rare adverse effect is important in the differential diagnosis of patients who have commenced on levothyroxine and have deranged liver enzymes in the context of hypothyroidism.

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Acute Liver Injury with Severe Coagulopathy in Marasmus Caused by a Somatic Delusional Disorder

Case Reports in Hepatology ◽

10.1155/2011/176894 ◽

2011 ◽

Vol 2011 ◽

pp. 1-2 ◽

Cited By ~ 1

Author(s):

Lance L. Stein ◽

Arun B. Jesudian

Keyword(s):

Anorexia Nervosa ◽

Liver Injury ◽

Calorie Restriction ◽

Acute Liver Injury ◽

Developed Countries ◽

Severe Form ◽

Delusional Disorder ◽

Protein Calorie Malnutrition ◽

Fat Stores ◽

Severe Coagulopathy

Marasmus is a severe form of protein-calorie malnutrition characterized by the depletion of fat stores, muscle wasting, and the lack of edema. In developed countries, marasmus is often the result of anorexia nervosa. Abnormal transaminases with liver synthetic dysfunction have rarely been reported with anorexia nervosa. To our knowledge, we report the first detailed case of acute liver injury with severe coagulopathy (INR>1.5) in a patient with marasmus due to self-induced calorie restriction caused by a somatic delusional disorder. This case highlights the severity of liver injury that may occur with significant weight loss from self-induced calorie restriction and the rapid normalization of this injury with treatment. It is important for clinicians to be aware of patterns of acute liver injury in patients with severe protein-calorie malnutrition, regardless of the underlying cause.

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