Advanced anorexia nervosa, associated with pneumomediastinum, pneumothorax, and soft-tissue emphysema without esophageal lesion.
OBJECTIVE
We describe the case of a 20-year-old female patient suffering from anorexia nervosa since the age 15 of years. When admitted, she was 168 cm tall with a weight of 35 kg (body mass index [BMI] = 12.4). A week after admission, the patient complained of retrosternal pain, and a few hours later she developed extensive soft-tissue emphysema.


METHODS
The X-ray picture of her thorax showed left-hand supraclavicular and infraclavicular emphysema, extensive emphysema in both sides of the soft tissue of the throat, a left-hand apical pneumothorax (4 mm), and a pneumomediastinum.


RESULTS
We discuss the extent to which these symptoms are interrelated in the sense of a causal nexus.


CONCLUSIONS
We ruled out any other differential-diagnostic etiopathogenic factors and concluded that the cause of our patient's soft-tissue emphysema, pneumothorax, and pneumomediastinum might well be autodestructive behavior.
Danzer
Gerhard
G
Department of Psychosomatic Medicine, Charité, Berlin, Germany. gerhard.danzer@charite.de
Mulzer
Johanna
J
Weber
Gerrit
G
Lembke
Alexander
A
Kocalevent
Rüya
R
Klapp
Burghard F
BF
D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D004947:Esophagus / Q000473:pathology; D005260:Female; D006801:Humans; D008478:Mediastinal Emphysema / Q000209:etiology*; D013902:Radiography, Thoracic; D012188:Retropneumoperitoneum / Q000209:etiology*; D013352:Subcutaneous Emphysema / Q000209:etiology*