Non-bacterial Thrombotic Endocarditis in a Patient With Anorexia Nervosa: A Case Report

TL;DR

A 28-year-old woman with anorexia nervosa developed a rare heart condition called non-bacterial thrombotic endocarditis, which was likely caused by severe malnutrition.

Contribution

This case report presents a rare instance of NBTE associated with anorexia nervosa rather than typical underlying conditions.

Findings

The patient showed improvement in nutritional status and resolution of heart vegetations after treatment.

NBTE was diagnosed after ruling out malignancy and autoimmune disease.

A multidisciplinary approach was essential for managing both the medical and psychiatric aspects of the case.

Abstract

Non-bacterial thrombotic endocarditis (NBTE) is a rare complication typically seen in association with malignancies, autoimmune diseases, and hypercoagulable states. Its occurrence in the context of severe malnutrition, particularly in anorexia nervosa, is extremely uncommon. This case describes a 28-year-old woman with a long-standing history of anorexia nervosa (restrictive subtype), who presented with fatigue, dizziness, and chest discomfort. Clinical examination revealed a systolic murmur, and echocardiography identified sterile vegetations on the mitral valve. Blood cultures were negative, and further evaluation ruled out malignancy and autoimmune disease, leading to a diagnosis of NBTE likely precipitated by profound malnutrition. The patient was managed with therapeutic anticoagulation, cautious nutritional rehabilitation, and intensive psychiatric support. Over a four-week hospitalization, she showed significant improvement in nutritional status and resolution of vegetations on follow-up imaging. This case highlights the need to consider NBTE in severely malnourished individuals and underscores the importance of a multidisciplinary approach to address both the medical and psychiatric dimensions of anorexia nervosa.

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