We report a case of a 45 year old Caucasian malnourished male with an history of
eating disorder who developed severe liver and pancreatic damage and multiorgan disfunction. At admission to our department, his body mass index (BMI) was 11.1. Biochemical evaluation showed elevated serum levels of
transaminases (AST= 2291 U/L, ALT= 1792 U/L),
amylase (3620 U/L),
lipase (4102 U/L), CPK= 1370 U/L, LDH= 2082 U/L. No other cause of acute liver and pancreatic damage was evidenced. Haematological disorders (
anemia,
thrombocytopenia,
leukopenia) found on admission seem related to bone marrow hypoplasia and to gelatinous marrow transformation described in severe state of
malnutrition. Although a moderate increase in liver and pancreatic
enzymes are a common finding in malnourished patients, only a small number of reports describes severe liver injury and multiorgan dysfunction. After a few days of treatment (hydration and
nutritional support) a marked decrease of serum
transaminases,
lipase,
amylase, CPK, LDH occurred, despite a transient increase in these levels secondary to
refeeding syndrome. The association of chronic
malnutrition and a decrease in systemic perfusion may be responsible for multiorgan dysfunction. In our patient the high levels of
transaminases and pancreatic
enzymes were the most important biochemical abnormalities normalized after refeeding.