27歳女性の「この口腔内写真」は何を物語るか？：NEJM

27歳女性の口腔内なのですって。ひどい齲歯、上口蓋のひどい潰瘍。binge-eatingというのがヒントになるのだが、これご存知かな？小生は知りませんでした。下の解説にある、bulimia nervosaというのは学生のころ習った。いずれにしても心療内科の代表疾患なのですな。

Images in Clinical 
Medicine 
Bulimia Nervosa 
Parish P. Sedghizadeh, D.D.S. N Engl J Med 2013; 368:1238　March 28, 2013

A 27-year-old woman presented with fatigue and a 4-day history of a painful sore in her mouth. Physical examination revealed a body-mass index (the weight in kilograms divided by the square of the height in meters) of 17.2, a deep ulcer of the posterior palate, severe tooth erosion with lingual decay, and swollen parotid glands. Laboratory studies revealed a serum potassium level of 2.6 mmol per liter and a bicarbonate level of 34 mmol per liter. The patient reported binge eating and self-induced vomiting several times daily. Given the binge-eating and purging behaviors, as well as hypokalemic metabolic alkalosis, palatal ulceration, and severe tooth erosion and decay, she was given a diagnosis of bulimia nervosa. Persons with eating disorders are likely to present in a primary care setting, and health care providers are in a unique position to identify the coexisting conditions and provide early detection, treatment, and appropriate referrals. This patient was hydrated with intravenous saline and was seen by the psychiatry and dentistry services. At the 1-year follow-up, the patient reported normal eating habits and her physical examination and results of laboratory tests were normal.


binge eating |bɪn(d)ʒ ˈiːtɪŋ|
noun [ mass noun ]
the consumption of large quantities of food in a short period of time, typically as part of an eating disorder.
DERIVATIVES
binge eater noun

多食症と拒食症でひろく多食症は拒食症に含まれるとかつてならった。拒食症の患者は、深夜丑三つ時に「多量の食べ物を詰め込めるだけ詰め込んで、やおら吐く。」ことがあるのだと。