Starvation-Induced Liver Injury During the Early Phase of Refeeding in a Patient With Anorexia Nervosa

We report a case of a 41-year-old woman with longstanding anorexia nervosa (AN) who developed marked elevation in transaminase levels during early refeeding with enteral nutrition. Imaging and lab studies excluded viral hepatitis, ischemic injury, and refeeding syndrome. Her liver enzymes rapidly normalized with continued caloric intake and weight gain. This case supports the concept of starvation-induced liver injury, possibly due to autophagy, and highlights the importance of distinguishing it from refeeding syndrome, as treatment strategies differ significantly. Body weight trends may aid in predicting the trajectory of liver injury during nutritional rehabilitation in AN.