Aims and Hypothesis: To present an academically interesting and clinically challenging case of a teenager presenting with refusal to eat or drink in the context of rigidity associated with autism spectrum disorder.
Background: Stereotypical behaviour with accompanying rigidity is one of the core features of autism spectrum disorders, leading to tantrums and difficulties in adapting to stressors or changes to usual routine. We are presenting a case of a 17 year old gentleman previously diagnosed with autism who presented to the acute medical hospital after refraining from eating or drinking for a number of days. This pervasive refusal put him at risk of starvation.
Method: This case relates to a referral for consultation made to the consult-liaison team at an acute medical hospital. The patient was reviewed at casualty and later in the ward. A case study was compiled using information obtained from medical records spanning the entirety of the individual’s inpatient stay.
Results: Medical admission for dehydration was required following refusal of all oral intake. Initial differential diagnosis included severe depression in the context of autism, with ECT considered as a possible treatment modality. A provisional diagnosis of worsening rigidity in the context of autism was however made. A nasogastric tube was inserted for nutrition, allowing administration of SSRI, benzodiazepines and later low-dose olanzapine. Clinical improvement was slow but sustained, augmented with behavioural techniques and family support, eventually leading to the removal of the tube and discharge.
Conclusions: This case highlights the morbidity associated with the rigidity of autism spectrum disorders, and how a careful holistic approach may prove extremely useful in treating potentially life-threatening refusal of oral intake.