title: Bullae, bronchiectasis and nutritional emphysema in severe anorexia nervosa.
abstract: OBJECTIVE
  Pulmonary complications of anorexia nervosa are rarely documented. The case of a patient with anorexia nervosa and pulmonary disease is presented, a new quantitative computed tomography (CT) method for the detection of emphysema is employed, the literature is reviewed and the concept of 'nutritional' emphysema is discussed.
  
  
  RESULTS
  The case of a 34-year-old, nonsmoking woman with long-standing severe anorexia nervosa who was evaluated for cough and progressive shortness of breath is reported. Pulmonary function testing showed a predominant restrictive pattern with a marked reduction in carbon monoxide transfer and respiratory muscle strength, and an elevated residual volume. Imaging revealed bullae and bronchiectasis, and quantitative analysis of the CT scan was consistent with mild, generalized emphysema. Bronchial washings grew Pseudomonas aeruginosa. Known causes for bronchiectasis were excluded. A literature review disclosed few reported noninfectious pulmonary complications of anorexia nervosa.
  
  
  CONCLUSIONS
  To the authors' knowledge, this is the first report of bullae and bronchiectasis in a patient with anorexia nervosa, and the CT analysis was consistent with mild emphysema. Malnutrition has been associated with emphysematous changes in animals and may be the primary insult in the development of emphysema, bullae and bronchiectasis in the present patient.
authors.affiliation: Respiratory Division, Department of Medicine, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia.
authors.forename: V J
authors.initials: VJ
authors.lastname: Cook
authors.forename: H O
authors.initials: HO
authors.lastname: Coxson
authors.forename: A G
authors.initials: AG
authors.lastname: Mason
authors.forename: T R
authors.initials: TR
authors.lastname: Bai
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications*; D001768:Blister / Q000209:etiology*; D001987:Bronchiectasis / Q000209:etiology*; D005260:Female; D006801:Humans; D011656:Pulmonary Emphysema / Q000209:etiology*