6th February 2024

A 23-year-old female presents to the acute medical unit with a one-month history of worsening shortness of breath and palpitation.

A 23-year-old female presents to the acute medical unit with a one-month history of worsening shortness of breath and palpitation. She also notes increasing lower limb oedema over this period. She denies any sensory or motor symptoms in her extremities. Her friends state she has been severely restricting her food intake for the past three years, mainly eating biscuits and white rice. No significant alcohol intake was reported.

Examination reveals a cachectic lady with a BMI of 13 and a MUST score of 5. Pitting oedema was noted up to her thighs. Normal heart sounds were noted, but she had a raised JVP. Blood test showed raised pro-BNP levels with echocardiogram showing reduced ejection fraction of 25% with increased cardiac output. Vitamin B1 levels were undetectable. 

Which of the following is the likely underlying diagnosis?