Pericardial and interstitial alcianophilic gelatinous degeneration in anorexia nervosa

Anorexia nervosa is associated with severe cardiovascular complications and an increased risk of sudden death. While cardiac atrophy is well recognized, unusual connective-tissue alterations of the heart are rarely described. A 28-year-old woman with a longstanding history of anorexia nervosa was found deceased at home. She was profoundly underweight, with extreme cachexia and a body mass index of 10.6. External examination revealed severe emaciation with near-complete loss of subcutaneous fat and marked muscular atrophy. Autopsy demonstrated near-total depletion of subcutaneous and visceral adipose tissue and a global cardiac atrophy. The epicardial surface appeared gelatinous and translucent, extending along the coronary arteries. Histological examination revealed extensive alcianophilic myxoid degeneration involving both the epicardium and myocardial interstitial tissue, confirmed by Alcian blue staining. This case represents an unprecedented example of combined epicardial and myocardial alcianophilic degeneration in severe anorexia nervosa, likely reflecting extreme connective-tissue remodeling due to profound malnutrition.