Autopsy findings and clinical course of severe anorexia nervosa complicated by spontaneous pneumothorax and bullous pulmonary emphysema: a case report

Abstract

Anorexia nervosa is a severe psychiatric disorder with systemic effects, such as life-threatening pulmonary complications. This case report investigates the pathological anatomy and clinical course of advanced anorexia nervosa complicated by bullous emphysema, spontaneous pneumothorax, and multiorgan failure. A retrospective clinical and autopsy analysis was conducted on a patient with severe anorexia nervosa (BMI 11.8) admitted for the following pulmonary complications: spontaneous pneumothorax and bullous emphysema. Clinical course, surgical interventions, laboratory data, and autopsy findings were reviewed to elaborate on the mechanisms and complications connected to this advanced malnutrition. The patient subsequently developed extensive pulmonary destruction, persistent air leaks, and infections secondary to this condition leading to respiratory failure and sepsis. Multiorgan involvement included myocardial dystrophy, polyfactorial anemia, thrombocytopenia, secondary immunodeficiency, and disseminated intravascular coagulation. Surgical management was complicated by failure of lung reinflation after collapse and progressive respiratory failure regardless of the segmentectomy performed. The progressive course and combined systemic risks illustrated the severity of complications in advanced anorexia nervosa. This case elucidates the multiorgan impact of anorexia nervosa and the challenges encountered in managing complex pulmonary complications and surgical risks. Clinicians should focus on early detection, aggressive primary care with attentive nutritional and infection control, and careful clinical judgment for surgery, when conservative therapy fails.