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

The Japanese term “hikikomori” represent a condition of selfisolation, predominantly seen in male adolescents and young adults. Hikikomori is associated with malnutrition, 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, as evidenced by an alarming increase during the COVID-19 pandemic. We present the case of a young man admitted to the emergency department with life-threatening malnutrition and anemia after prolonged selfisolation 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. 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.