ANOREXIA NERVOSA IN AN OSTEOSARCOMA SURVIVOR: SEVERE CACHEXIA COMPLICATED BY PANCYTOPENIA, DYSELECTROLYTEMIA, AND METABOLIC COLLAPSE

Anorexia Nervosa (AN) presents a unique diagnostic challenge in cancer survivors, where severe malnutrition can physiologically mimic metastatic recurrence. The sequelae of starvation—including "starvation marrow" and metabolic collapse—create a complex clinical picture often indistinguishable from terminal malignancy. We report the case of a 27-year-old osteosarcoma survivor who presented with profound cachexia and drowsiness following a history of chronic constipation and laxative abuse. Her clinical course was complicated by life-threatening instability, including profound hypoglycemia (25 mg/dL), sinus bradycardia (46 bpm), and marked QTc prolongation (654 ms). Additionally, she exhibited pancytopenia (Hb 7.1 g/dL, Platelets 24,000/mm³), initially raising concern for bone marrow metastasis. This case highlights the critical need to distinguish starvation physiology from oncologic progression to ensure appropriate management.