A case of a 20-yr-old female with possible "alcoholic hepatitis" and a mixed micro/macronodular cirrhosis occurring in association with overt bulimia and a history of anorexia nervosa, but without any objective evidence of either alcoholism or alcohol abuse, is reported. The possible factors that may have contributed, either alone or in combination, to produce this unusual occurrence are discussed.
Anorexia nervosa and bulimia are increasingly common problems in western societies. Recent studies have reported that the prevalence of these two disorders is considerable, affecting as many as 5 to 10% of adolescent girls and young adult women between the ages of 12 and 30 (1-5). Such women manifest a compulsive pattern of eating and purging behavior which, in combination with environmental pressures (e.g., family, friends, job, etc.), puts them at increased risk for developing such problems as drug abuse, alcohol abuse and other types of addictive psychosocial problems (2,(6)(7)(8)(9)(10)(11).
Clinically important liver disease associated with either anorexia nervosa or bulimia has not heretofore been described. Herein, we report a case of possible "alcoholic hepatitis" and cirrhosis in a 20-yr-old white female former anorectic who, when initially seen, was practicing bulimia and had only a modest alcohol intake as documented by history, absence of alcohol withdrawal and normal results on an alcohol inventory measuring the quantity, frequency and effects of current and recent alcohol beverage consumption.
CASE PRESENTATION
J. P. is a 20-yr-old white female who was admitted to the hospital on July 10,1985 because of progressive dull right upper quadrant abdominal pain and jaundice of 1 week duration. She had a history of anorexia nervosa which lasted for 9 months (about 5 yr earlier). Since then, she has been bulimic. Specifically, she states that she eats regularly with her family, but 5 to 10 min after each meal, she retires to the bathroom and induces vomiting to maintain her current weight (105 lbs) and physical appearance. In addition, she routinely drinks one to