Adult acetonemic vomiting complicated with low body weight in a subject with Mycobacterium avium complex pulmonary disease: a case report

Abstract

Pulmonary diseases often cause significant health issues and nutritional disorders. Weight loss and malnutrition are related to the severity of obstructive disorders. Therefore, patients with such conditions often experience low nutritional energy. Acetonemic vomiting is caused by acetonemic syndrome. Previously, it was believe that acetonemic vomiting was observed only in childhood. However, it was recently suggested that acetonemic vomiting can also occur in adults. It is also considered that acetonemic vomiting can occur in subjects with low body weight because stored carbohydrate levels are reduced and fats are mainly used for energy. Consequently, large amounts of acetone are produced, ultimately resulting in nausea and vomiting. In this study, we report a case of adult acetonemic vomiting complicated by low body weight in a subject with Mycobacterium avium complex pulmonary disease.

Keywords: Acetonemic vomiting; Mycobacterium avium complex pulmonary disease; acetone; adult; low body weight; mild hypoglycemia; obstructive disorder.

Figure 1.

Imaging findings. (a) Chest X-ray revealed multiple small nodular shadows and (b) Chest computed tomography revealed consolidation including bronchiectasis.

Figure 2.

Time course of clinical parameters in this subject. This patient was hospitalized five times including this admission for only 1 year. She was malnourished (low albumin and cholinesterase levels). In addition, during each hospitalization, she exhibited nausea and vomiting together with hypoglycemia and ketosis. BW, body weight; BP, blood pressure; WBC, white blood cell; Eosino, eosinophil; Na, sodium; Alb, albumin; ChE, cholinesterase.

Figure 3.

Time course of MAC pulmonary disease radiologic findings in this subject over the last 10 years. Positivity for MAC was confirmed by antibody testing and polymerase chain reaction, and the patient exhibited severe weight loss. This patient experienced polymyalgia rheumatic and rheumatoid arthritis, but she had already displayed severe weight loss before the onset of these conditions. MAC, Mycobacterium avium complex; N/A, not applicable.