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Case Reports in Hepatology
Volume 2011, Article ID 176894, 2 pages
Case Report

Acute Liver Injury with Severe Coagulopathy in Marasmus Caused by a Somatic Delusional Disorder

1Piedmont Transplant Institute, Piedmont Hospital, 1968 Peachtree Road NW, 77 Building, 6th Floor, Atlanta, GA 30309, USA
2Division of Gastroenterology, New York Presbyterian Hospital, Weill Medical College of Cornell University, 1305 York Avenue, 4th Floor, New York, NY 10021, USA

Received 13 May 2011; Accepted 6 July 2011

Academic Editors: A. Grasso and C. Karaca

Copyright © 2011 Lance L. Stein and Arun B. Jesudian. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Marasmus is a severe form of protein-calorie malnutrition characterized by the depletion of fat stores, muscle wasting, and the lack of edema. In developed countries, marasmus is often the result of anorexia nervosa. Abnormal transaminases with liver synthetic dysfunction have rarely been reported with anorexia nervosa. To our knowledge, we report the first detailed case of acute liver injury with severe coagulopathy ( I N R > 1 . 5 ) in a patient with marasmus due to self-induced calorie restriction caused by a somatic delusional disorder. This case highlights the severity of liver injury that may occur with significant weight loss from self-induced calorie restriction and the rapid normalization of this injury with treatment. It is important for clinicians to be aware of patterns of acute liver injury in patients with severe protein-calorie malnutrition, regardless of the underlying cause.