Severe Malnutrition in a Young Adult: Diagnostic Challenges in a Multifactorial Case With Helicobacter pylori...

Severe malnutrition in adults is frequently multifactorial and may result from overlapping nutritional, infectious, inflammatory, and systemic conditions. Identifying the dominant contributors can be challenging, particularly when patients present without classic gastrointestinal symptoms. We report the case of a 24-year-old woman with a more than 10-year history of failure to gain weight despite adequate nutritional intake, associated with progressive bilateral lower limb weakness, anasarca, delayed pubertal development with primary amenorrhea, and severe functional decline. Despite multiple hospitalizations and nutritional interventions, her condition continued to deteriorate. Comprehensive evaluation revealed Helicobacter pylori (H. pylori)-associated gastritis with micronutrient deficiencies, while further investigation identified a right psoas abscess associated with a marked systemic inflammatory response. Management included H. pylori eradication therapy, surgical drainage of the abscess, antibiotic therapy, and structured nutritional rehabilitation. The patient subsequently experienced substantial weight gain, resolution of edema, restoration of mobility, attainment of menarche, and sustained clinical recovery. This case highlights the multifactorial nature of severe malnutrition and the potential contribution of both chronic gastrointestinal infection and occult deep-seated infection to nutritional decline. In patients with unexplained severe malnutrition accompanied by disproportionate inflammatory markers, clinicians should maintain a high index of suspicion for occult infectious foci and consider early imaging to avoid diagnostic delay and facilitate timely intervention.