Case 21-2012

A 27-year-old man presented with fatigue, weakness, weight loss, and decreased libido, which persisted despite significant weight loss through diet and exercise. His symptoms included arm weakness, leg numbness, and a faint rash. Extensive testing ruled out infections and autoimmune diseases, and imaging showed no significant abnormalities. Physical examination revealed cachexia, muscle wasting, and decreased testicular size. Despite normal levels of many hormones and nutrients, his condition did not improve with treatments, including testosterone gel. The case highlighted the complexity of diagnosing and managing unexplained systemic symptoms in a young patient. Ultimately, the clinical picture, including bradycardia, hypothermia, and hypoglycemia, strongly suggested anorexia nervosa, necessitating urgent refeeding and careful monitoring. The patient was diagnosed with anorexia nervosa, severe malnutrition, and acute liver dysfunction, and was hospitalized for 25 days, showing some improvement but refusing further inpatient psychiatric treatment.