Hindawi Publishing Corporation Case Reports in Medicine Volume 2009, Article ID 841037, 3 pages doi:10.1155/2009/841037 Case Report Delayed Diagnoses: Nonspeciﬁc Findings and Diagnostic Challenges in Eating Disorders Dan Schwarz,1, 2 Kathryn L. Ponder,1 and Edward R. Feller3 1 Alpert School of Medicine, Brown University, Providence, RI, USA 2 Harvard School of Public Health, Harvard University, Boston, MA, USA 3 Department of Internal Medicine, Alpert School of Medicine, Brown University, Providence, RI, USA Correspondence should be addressed to Dan Schwarz, dan schwarz@brown.edu Received 26 April 2009; Accepted 12 July 2009 Recommended by Aliza Zeidman Objective. Eating disorders commonly present with nonspeciﬁc ﬁndings, masquerading as other, more common etiologies of malnutrition and wasting. In low-prevalence populations, these ambiguities can complicate clinicians’ diagnostic reasoning, resulting in delayed or missed diagnoses. Method. We report the atypical case of a 51-year-old male with a ﬁve-year history of unexplained weight loss despite extensive past medical evaluation. Previous documentation of profound lymphopenia and bone marrow atrophy had not been linked to a known association with eating disorders. Results. Evaluation for medical etiologies of wasting was negative. Following psychiatric evaluation, the patient was diagnosed with an eating disorder, not otherwise speciﬁed, and admitted to a specialized nutritional rehabilitation program. Conclusion. The nonspeciﬁc clinical history, physical exam, and laboratory abnormalities of eating disorders can make these diagnoses challenging and delay appropriate treatment. Clinicians should consider eating disorders in patients with malnutrition, severe lymphopenias, and gelatinous marrow transformation early in their workup, so as to avoid potentially negative outcomes. Copyright © 2009 Dan Schwarz et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Eating disorders currently aﬀect ﬁve to ten million American females and as many as one million American males [1]. Clinical presentation may be nonspeciﬁc, mimicking the signs and symptoms of other common medical etiologies of malnourishment. This is especially true in males and even more so with middle-aged males in whom the diagnoses of eating disorders may not be considered [2]. We report the case of an atypical eating disorder in a 51-year-old male with a long-standing history of progressive wasting and unusual severe hematologic abnormalities. 2. Case Report A 51-year-old male, with a ﬁve-year history of a progressive unexplained 50 pound weight loss, presented with one week of worsening generalized weakness and diminished ability to perform activities of daily living. Physical exam was notable for a temperature of 35.9◦C with orthostatic hypotension. He was cachectic with extensive muscle wasting, kyphosis, and 2+ bilateral pitting edema in the lower extremities. BMI was 14.8 kg/m2. His medical history was remarkable for prior extensive negative evaluations for infection, neoplasm, malabsorp- tion, or metabolic disease. He had received care from his primary medical doctor as well as a gastroenterologist, endocrinologist, hematologist, and several complementary and alternative care providers. Laboratory results, imaging studies, and multiple GI endoscopies had not demonstrated a medical cause for the patient’s persistent malnourishment and continued weight loss. Bone marrow biopsy four years earlier was remarkable for a hypocellular marrow with gelatinous transformation. Complete blood count at that time revealed a normocytic anemia (Hgb: 11.1 g/dl, MCV: 97.9 fL), leukopenia (2.9 × 109/L), and severe lymphopenia (0.6 × 109/L). Two DEXA bone scans (in 2005 and 2006) demonstrated worsening osteoporosis, with lumbar T-scores of −3.4 and −3.6, and femoral T-scores of −3.4 and −3.6, respectively.