Autopsy Report for an Anorexia Nervosa Patient Who Died of Hemorrhagic Necrotic Colitis due to Suspected Clostridium perfringens Infection

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  • Nishida Shinji
    Department of Kampo Medicine, Osaka University Graduate School of Medicine
  • Koyama Atsuko
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine
  • Matsuoka Hiromichi
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine
  • Hirano Tomoko
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine
  • Jinnai Rikako
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine
  • Tochihara Kyoko
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine
  • Iwagami Kaori
    Department of Psychosomatic Medicine, Sakai Hospital Kinki University School of Medicine

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Other Title
  • ウェルシュ菌を疑われる起炎菌により,出血性壊死性腸炎にて死亡した神経性食思不振症患者の剖検例
  • 症例研究 ウェルシュ菌を疑われる起炎菌により,出血性壊死性腸炎にて死亡した神経性食思不振症患者の剖検例
  • ショウレイ ケンキュウ ウェルシュキン オ ウタガワレル キエンキン ニ ヨリ シュッケツセイ エシセイ チョウエン ニテ シボウシタ シンケイセイ ショクシ フシンショウ カンジャ ノ ボウケンレイ

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Abstract

The patient was a 23-year-old woman. In September "X-2" year, she visited our hospital due to excessive weight loss. Anorexia nervosa was diagnosed and she was hospitalized the same day. Condition improved with behavior therapy at the hospital and she was discharged in December. However, she discontinued follow-ups at the hospital until June "X-1" year. On February 1, "X" year, the patient experienced abdominal pain during the night, so she visited another hospital and received drip infusion. Condition worsened and she was brought to our hospital the next morning. On arrival, she was severely emaciated and in shock, so immediate rescue with artificial respiration and drip infusion of saline, corticosteroid, vasopressor and bicarbonate was initiated. Condition improved temporarily, but paralytic ileus and gastrointestinal bleeding developed and she died 17h after arrival. Based on autopsy findings and clinical symptoms, hemorrhagic necrotic colitis, pneumatosis cystoids intestinalis and hepatic portal vein gas were diagnosed. Clostridium perfringens was considered as the causative agent. This bacterium is widely distributed in the environment and frequently occurs in the intestinal tract of humans and many domestic and feral animals. Complications and death only occur very rarely. However, in malnourished patients with poor immune status as seen with anorexia nervosa, C. perfringens may cause severe disease.

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