Cardiohistological Findings in Refeeding Syndrome

Severe eating disorders may develop refeeding syndrome, which sometimes resembles severe cardiac dysfunction. A woman in her thirties was admitted to our hospital because of cardiogenic shock. Transthoracic echocardiography showed reduced left ventricular systolic function. In her medical history, she had been diagnosed with refeeding syndrome. A ventricular endocardial biopsy was performed to exclude other cardiac diseases. A histological examination showed conspicuously atrophied cardiomyocytes with nuclear swelling and irregularities; the myocardial sequence was disturbed with fibrosis. Immunostaining revealed that lipid droplet markers, adipose triglyceride lipase, and perilipin 2 were poorly observed in the cardiomyocytes, while expression of both proteins was attenuated in fibroblasts within the myocardial layer. The abnormal metabolism of fatty acids was the presumed cause of cardiac dysfunction.