Providencia rettgeri and Group G Streptococcus in Anorexia Nervosa-Related Empyema: A Case Report

BACKGROUND Anorexia nervosa, predominantly affecting young females, significantly compromises the immune system, rendering patients vulnerable to infections and contributing to a notably high mortality rate. The complexities involved in managing infections in immunocompromised patients with anorexia nervosa are often underappreciated. This case report aims to shed light on these challenges and the potential complications arising from treatment interventions. CASE REPORT We present the case of a 30-year-old woman with a long-standing history of anorexia nervosa, who was admitted with severe systemic symptoms, including profound weakness and numbness in her extremities. Initial laboratory tests revealed severe renal failure and marked dyselectrolytemia. On day 14 of hospitalization, the patient developed empyema thoracis, an uncommon but severe complication in patients with anorexia nervosa. The empyema was caused by Providencia rettgeri and group G Streptococcus, suggesting aspiration of oral secretion was the etiology. Despite appropriate antibiotic therapy, the condition recurred, likely exacerbated by the administration of corticosteroids to manage concurrent thrombocytopenia, which further compromised the patient's already weakened immune system. CONCLUSIONS This case underscores the critical need for careful consideration of the immunosuppressive effects of treatments like corticosteroids in anorexia nervosa patients, who are already at heightened risk for severe infections such as empyema thoracis. It highlights the importance of vigilant monitoring and tailored management strategies for infections in these patients, emphasizing a multidisciplinary approach to optimize outcomes in similar clinical scenarios. The case provides valuable insights into balancing the benefits and risks of immunosuppressive therapies in the management of anorexia nervosa and associated complications.