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Multifocal germinoma masquerading as avoidant restrictive food intake disorder: a case of severely decreased food intake and malnutrition

European Journal of Clinical Nutrition volume 76, pages 173–176 (2022)Cite this article

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Abstract

A young woman presented with significant weight loss and malnutrition secondary to decreased food intake. Her presentation was felt to be consistent with a psychiatric diagnosis of avoidant restrictive food intake disorder (ARFID). She received 3 years of treatment for ARFID, but failed to make significant progress and ultimately required a feeding tube. Incidentally, she noted severe visual field changes at this time, which triggered further workup including an MRI of the head. This revealed the true diagnosis of a suprasellar and pineal germinoma. There are several cases in the literature of germinomas presenting with decreased food intake that were misdiagnosed as anorexia nervosa. However, this is the first reported case of a multifocal germinoma presenting as ARFID. Criteria for the diagnosis of ARFID do not include body image distortion, potentially making this eating disorder more prone to misdiagnosis.

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Fig. 1: Automated visual field (Humphrey 24-2).
Fig. 2: Post contrast sagittal T1 MRI of the brain.

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Author information

Authors and Affiliations

  1. Department of Ophthalmology, Western University, London, ON, Canada

    Heather M. McDonald, Tony Lin & Lulu L. C. D. Bursztyn

  2. Centre for Neuroscience Studies, Western University, London, ON, Canada

    Lulu L. C. D. Bursztyn

Authors
  1. Heather M. McDonald
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  2. Tony Lin
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  3. Lulu L. C. D. Bursztyn
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Contributions

HMM was responsible for assessing the patient on initial presentation, obtaining consent from the patient, collecting data from the patient’s chart, performing a literature review, and writing the manuscript. TL was responsible for assessing the patient on initial presentation, performing initial investigations, synthesizing the data, and writing/editing the manuscript. LLB was responsible for assessing and providing ongoing management to the patient, synthesizing the data, and writing/editing the manuscript.

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Correspondence to Heather M. McDonald.

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McDonald, H.M., Lin, T. & Bursztyn, L.L.C.D. Multifocal germinoma masquerading as avoidant restrictive food intake disorder: a case of severely decreased food intake and malnutrition. Eur J Clin Nutr 76, 173–176 (2022). https://doi.org/10.1038/s41430-021-00896-4

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  • DOI: https://doi.org/10.1038/s41430-021-00896-4

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