Achalasia mimicking prepubertal anorexia nervosa.
A 9-year-old girl presents for continuing weight loss of 10 kg over the course of 1 year. Medical history showed three episodes of pneumonia requiring hospital admission in the 6 months before presentation and 4 months of weekly psychotherapy for anorexia nervosa. A thorough history of eating behavior and a review of systems revealed not only typical aspects of prepubertal anorexia nervosa but also vomiting at night while asleep, difficulty drinking liquids, epigastric pain, and a frequent experience of "a lump in the throat"; these symptoms were not suggestive of a diagnosis of anorexia nervosa but rather of esophageal achalasia. The patient was transferred to the Department of Pediatrics, and a diagnosis of esophageal achalasia was made by chest x-ray and barium swallow. After dilatation and botulinum toxin application, the patient regained weight easily and was discharged in stable condition. In this case, esophageal achalasia mimicked prepubertal anorexia nervosa.
Richterich
Andreas
A
Department of Child and Adolescent Psychiatry, University of Heidelberg, Blumenstrasse 8, 69115 Heidelberg, Germany.
Brunner
Romuald
R
Resch
Franz
F
D017668:Age of Onset; D000856:Anorexia Nervosa / Q000175:diagnosis*; D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000627:therapeutic use; D002648:Child; D003937:Diagnosis, Differential; D004106:Dilatation; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006801:Humans; D011014:Pneumonia / Q000209:etiology; D011627:Puberty; D016896:Treatment Outcome; D015431:Weight Loss
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins