Hikikomori, a risk factor for life-threatening malnutrition: a case report of an emergency within the vulnerability

Background:  the  Japanese  term  hikikomori  represent  a  condition  of  self-isolation,  predominantly  seen  in  male  adolescents  and  young  adults  [1].  Hikikomori  is  associated  with  malnutrition[1],  mood  disorders,  self-neglect,  and  reduced  access  to  healthcare.  Although  initially  observed  and  described  in  Japan,  this  psychiatric  condition  has  become  a  global  phenomenon  in  recent  years,  with  an  important  burden  on patients  and  their  families.  Hikikomori  syndrome  can  be  especially  dangerous  when  compounded  by  psychiatric  comorbidities  or  socioeconomic  vulnerabilities,  [2],  as  evidenced  by  an  alarming  increase  during  the  COVID-19  pandemic.

Case  report:    We present the case of a young man admitted to the emergency department with life-threatening malnutrition and anemia after prolonged self-isolation following  cyberbullying  episodes. The patient was found in critical condition, suffering from shock and multiorgan failure. After initial emergency interventions, and post-stabilization,  he was transferred to psychiatric care. 

Why  should  an  emergency  physician  be  aware  of  this?  Emergency  physicians  should  start  considering  hikikomori  as  a  risk  factor  in  the  assessment  of  malnutrition  and  anaemia,  above  all  in  young  adults.  In  addition,  we  want  to  highlight  how  much  the  COVID-19  pandemic  exacerbated  the  critical  issues  of  local  medicine,  exposing  the  most  vulnerable  to  greater  risk.  The  Emergency  Department  necessitates  a  more  integrated  approach  with  social  and  out-of-hospital  health services  for  intercepting  and  addressing  the  needs  of  vulnerable  individuals.