A young female patient with anorexia nervosa complicated by Mycobacterium szulgai pulmonary infection.

Objective Pulmonary infection with a rare atypical mycobacterium, Mycobacterium szulgai, was discovered during the treatment of anorexia nervosa in a 21-year-old Japanese woman without preexisting pulmonary disease. She had a long history of low body weight below 35kg. Methods On admission, she was examined. She weighed 23kg and presented with hypoproteinemia, decreased levels of rapid turnover proteins, liver dysfunction, and decreased serum level of insulin-like growth factor-I. Results Although she had had neither clinical symptom specific for mycobacterium pulmonary infection nor inflammatory data, a chest roentgenogram showed an infiltrative shadow with cavity formation in the right upper lung field. Isolated bacteria from sputum was acid-fast bacilli and identified as M. szulgai using the DNA-DNA hybridization method. Discussion In anorexia nervosa patients with a long history of severe malnutrition, special attention must be paid to the possibility of opportunistic infections, even in the absence of symptoms or inflammatory data. © 2003 by Wiley Periodicals, Inc. Int J Eat Disord 35: 115–119, 2004.